Archives of Iranian Medicine最新文献

Background: Iran's healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran's public hospitals.

Methods: This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP's actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap.

Results: The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, P<0.001), females (B=26.7, 95% CI: 15.5-37.9, P<0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, P<0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, P<0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, P<0.001).

Conclusion: Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.

Background: Colorectal cancer (CRC) ranks as the third most common cancer worldwide, significantly contributing to cancer-related deaths and increasingly affecting younger populations. Although its impact on patients' quality of life is profound, scientometric studies on CRC remain underexplored. The objective of this study was to evaluate the scientific literature on CRC from 2014 to 2023, employing a range of scientometric and statistical approaches.

Methods: This study obtained CRC-related publications from the Scopus database. The analyses of the collaboration and co-occurrence among countries/regions, institutions, journals, references, authors, and keywords were conducted utilizing VOSviewer, facilitating the identification of key research trends and emergent subjects.

Results: A review of Scopus entries yielded 200,385 papers on CRC in the last decade, noting a yearly increase in publications from 2014 to 2023. China emerged as the most prolific contributor with 46,674 documents. A positive correlation was identified between a country's CRC research output and gross domestic product (GDP; r=0.961, P<0.001). The journal "Cancers" led to 3006 articles, and H. Brenner stood out as the foremost author with 452 publications. However, the Ministry of Education of the People's Republic of China led institutional contributions to 3094 papers.

Conclusion: With a leading count of 46674 articles, China dominated CRC research, particularly highlighted by the Ministry of Education of the People's Republic of China. The primarily obtained keywords were CRC, cancer, prognosis, rectal cancer, and colon cancer. Despite the presence of global collaborations, there is a pressing need for increased research funding and support in the CRC, especially within developing nations. This study is a navigational tool for medical professionals, researchers, and surgical assistants to grasp the international progress and directions in CRC research.

Background: Post-traumatic stress disorder (PTSD) is a disorder that arises from experiencing traumatic events such as traffic accidents, war, natural disorders, and job incidents. This study focused on determining the epidemiology of PTSD in the Iranian population from 2019 to 2024.

Methods: In this systematic review and meta-analysis, we explored databases such as PubMed, Embase, Web of Knowledge, Scopus, and Magiran to achieve a maximum variety of screened articles. The quality of the included articles was evaluated using the STROBE checklist. For data analysis, due to the variation in reporting the PTSD prevalence across the reviewed articles, heterogeneity was assessed using the I² index, and a random effect model was applied to account for this variation.

Results: Out of 800 articles found in the initial review, only 15 articles were entered in the final analysis based on inclusion and exclusion criteria, with a total of 9868 participants. The overall PTSD prevalence in the Iranian population was 31.87% (95% confidence interval [CI]=17.87- 45.87, I²=95.29%, P<0.001). Additionally, PTSD prevalence in men (36.64%) was higher than in women (35.52%).

Conclusion: The prevalence of PTSD in young Iranian men is relatively high, and there was no statistically significant decrease in PTSD prevalence between 2019 and 2024.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant global health burden without established curative therapies. Early detection and preventive strategies are crucial for effective MASLD management. This study aimed to develop and validate machine-learning (ML) algorithms for accurate MASLD screening in a geographically diverse, large-scale population.

Methods: Data from the prospective Fasa Cohort Study, initiated in rural Fars province, Iran (March 2014), were employed for this purpose. The required data were collected using blood tests, questionnaires, liver ultrasonography, and physical examinations. A two-step approach identified key predictors from over 100 variables: (1) statistical selection using mean decrease Gini in random forest and (2) incorporation of clinical expertise for alignment with known MASLD risk factors. The hold-out validation approach (with a 70/30 train/validation split) was utilized, along with 5-fold cross-validation on the validation set. Logistic regression, Naïve Bayes, support vector machine, and light gradient-boosting machine (LightGBM) algorithms were compared for model construction with the same input variables based on area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.

Results: A total of 6,180 adults (52.7% female) were included in the study, categorized into 4816 non-MASLD and 1364 MASLD cases with a mean age (±standard deviation [SD]) of 48.12 (±9.61) and 49.47 (±9.15) years, respectively. Logistic regression outperformed other ML algorithms, achieving an accuracy of 0.88 (95% confidence interval [CI]: 0.86-0.89) and an AUC of 0.92 (95% CI: 0.90-0.93). Among more than 100 variables, the key predictors included waist circumference, body mass index (BMI), hip circumference, wrist circumference, alanine aminotransferase levels, cholesterol, glucose, high-density lipoprotein, and blood pressure.

Conclusion: Integration of ML in MASLD management holds significant promise, particularly in resource-limited rural settings. Additionally, the relative importance assigned to each predictor, particularly prominent contributors such as waist circumference and BMI, offers valuable insights into MASLD prevention, diagnosis, and treatment strategies.

Background: While cardiovascular disease (CVD) polypills have demonstrated significant benefits in preventing CVD events by managing CVD risk factors and improving patient adherence, their effects on blood glucose levels, an important risk factor for CVD, remain unknown.

Methods: We analyzed data from the PolyIran-Liver trial, which involved 1,508 participants aged 50 and above. Of these, 787 were randomly assigned to receive a polypill (consisting of aspirin, atorvastatin, hydrochlorothiazide, and valsartan), while 721 received usual care as the control group over a five-year period. The aim was to determine whether there were any significant differences in fasting blood sugar (FBS) levels between the two groups at baseline, middle, and end of the study. The data analysis focused on three subgroups: participants with diabetes, those with metabolic syndrome (MetS) but without diabetes, and participants without diabetes or MetS.

Results: Of the total studied population, with a mean age of 59±6.7 years, 328(22%) were identified with diabetes, 371 (25%) with MetS but without diabetes, and 809 (54%) without diabetes or MetS. We observed a trend of rising FBS levels until month 30, followed by a subsequent decline at month 60. Participants in the polypill group exhibited lower FBS levels than the control group at both time points, with statistically significant differences in all three subgroups at month 30 and in the MetS-without diabetes at month 60 (mean difference: -9.3 mg/dl, 95% CI: 13.9 to -4.6).

Conclusion: The polypill used in this study may have the potential to delay the onset of diabetes in patients with MetS more effectively than in the general population. However, its beneficial effects on the blood sugar levels of diabetic individuals require further investigation.

Doctor Joseph Désiré Tholozan was a French physician who became the special physician of Nassereddin Shah, King of Persia (Iran) in the 19^th century. He studied lots of topics in the field of epidemiology of infectious diseases. His efforts led to the discovery of the main vector of Iranian tick-born relapsing fever, Ornithodoros tholozani. He was also one of the pioneers of the Iranian Sanitary Council, whose efforts led to the foundation of the Ministry of Health of Iran a few decades later. This paper is a brief review of his biography and his roles in promoting health in Iran in the 19^th century.

Background: Annually, 3-8 million infants are born with congenital anomalies worldwide, ranging from 3% to 7% of births in different countries. This study aimed to investigate the nationwide epidemiological features of birth defects in Iran.

Methods: This cross-sectional study was conducted in six major regions across Iran. The data sources were the maternity facilities affiliated with regional universities of medical sciences. All children were examined by obstetricians, pediatricians, or midwives at birth, and newborns were followed until discharge from the facility for health status, maturity, and congenital defects.

Results: A total of 138,643 births were registered in the maternity facilities across the study regions. Among these newborns, 3,458 cases were diagnosed with congenital anomalies, representing an overall prevalence rate of 249.4 per 10000 births (95% CI: 241.2-257.8). Genital organ anomalies exhibited the highest rates of defects in the country with 92.7 per 10000 births (95% CI: 86.4-98.9), followed by limb anomalies at 83.3 per 10000 births (95% CI: 77.4-89.3). The prevalence of respiratory system, chromosomal, and urinary tract anomalies was less than 10 per 10000 births.

Conclusion: Until a national registry for congenital anomalies is established, this study provides essential data on the magnitude of the health problems caused by congenital anomalies in Iran. The findings would be vital for planning and evaluating antenatal screening for birth defects, particularly for high-risk groups and regions in the country.

Background: Neonatal acute respiratory distress syndrome (NARDS) is an important cause of hypoxemic respiratory failure. This study aimed to investigate the short-term effects of endotracheal surfactant and budesonide combination therapy on NARDS secondary to late-onset neonatal sepsis (LONS).

Methods: This was a retrospective, cross-sectional, and observational study. Newborns with NARDS due to LONS who received endotracheal surfactant and budesonide combination therapy between August 2022 and September 2023 were included in this study. Oxygenation status before endotracheal surfactant and budesonide treatment were compared with the values obtained two hours after treatment.

Results: Among 20 neonates, 10 (50%) were diagnosed with severe NARDS, and 10 (50%) were diagnosed with moderate NARDS. The mean corrected gestational age was 33.3±2.9 w when endotracheal surfactant and budesonide were administered to the neonates. The need for the fraction of inspired oxygen (0.75 [0.57-1.00]% vs. 0.55 [0.44-0.80]%; mean difference [MD]: 17.50%, 95% confidence interval [CI]: 14.99 to 22.50) and oxygen saturation index (OSI; 8.03 [4.98-13.94] vs. 4.71 [4.11-8.93]; MD: 2.23, 95% CI: 1.22 to 3.24) decreased (P=0.001 and P<0.001, respectively) after endotracheal surfactant and budesonide treatment. However, preductal oxygen saturation (SpO₂ ; 93 [91-94]% vs. 95 [94-96]%; MD: -3.50%, 95% CI: -5.00 to -2.00) increased significantly after endotracheal surfactant and budesonide treatment when compared to pre-treatment values (P<0.001).

Conclusion: The reduction in oxygen demand and OSI, along with an increase in SpO₂ after treatment compared to pre-treatment values, suggests that endotracheal surfactant and budesonide combination therapy could be an effective option to improve oxygenation in NARDS secondary to LONS.

Background: A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran.

Methods: In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes.

Results: The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources.

Conclusion: The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system.

Background: Cardiovascular diseases (CVDs) account for one-third of all deaths worldwide.

Methods: In this cross-sectional study, we extracted all death records from the Electronic Death Registration System categorized as ischemic heart disease (IHD) based on age, gender, and the year of death according to ICD-10 for this cross-sectional analysis. The Fars province is situated in southern Iran with a population of about 4 million. An analysis of years of life lost (YLL) resulting from premature death from IHD was conducted using the World Health Organization's 2015 YLL framework. The trend of the YLL rates was investigated using joinpoint regression.

Results: In the Fars province, IHD was the cause of 46969 deaths throughout a 16-year study period, (2004 to 2019). Among these, 26,503 (56.4%) were men. The crude death rates per 100000 population for men and women were 84.2 and 66.5, respectively. The total YLL due to premature death due to IHD, during the 16-year study period, was 287625 in male, 209665 in female. The joinpoint regression showed a declining trend in the YLL rate associated with premature death. Annual Percent Change (APC) was -0.6% (95% CI -6.9 to 6.1, P=0.851) for males and -1.5% (95% CI -5.2 to 2.2, P=0.418) for females.

Conclusion: The trends of the standardized mortality rate, YLL, and crude mortality rate held steady throughout a 16-year period. Planning for comprehensive primary and secondary prevention and increasing public knowledge of IHD are necessary.