The Dilemma of Underutilized Health Insurance: A Matched Case-Control Study Investigating Reasons in Iran's Free Universal Health Insurance.

Background: In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran; it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks. Methods: In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2:1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model. Results: Unemployment (Odds Ratio (OR)=8.33, 95% Confidence interval (CI): 1.05-50.0), being single (OR=3.69, CI: 1.18-11.55), low economic status (OR=1.85, CI: 1.02-3.33) and attitude towards performance of health insurance (OR=0.86, CI: 0.75-0.99) were affected not having health insurance. Conclusion: Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices.

A Bayesian network based study on determining the relationship between job stress and safety climate factors in occurrence of accidents.

BACKGROUND: Job stress and safety climate have been recognized as two crucial factors that can increase the risk of occupational accidents. This study was performed to determine the relationship between job stress and safety climate factors in the occurrence of accidents using the Bayesian network model. METHODS: This cross-sectional study was performed on 1530 male workers of Asaluyeh petrochemical company in Iran. The participants were asked to complete the questionnaires, including demographical information and accident history questionnaire, NIOSH generic job stress questionnaire, and Nordic safety climate questionnaire. Also, work experience and the accident history data were inquired from the petrochemical health unit. Finally, the relationships between the variables were investigated using the Bayesian network model. RESULTS: A high job stress condition could decrease the high safety climate from 53 to 37% and increase the accident occurrence from 72 to 94%. Moreover, a low safety climate condition could increase the accident occurrence from 72 to 93%. Also, the concurrent high job stress and low safety climate could raise the accident occurrence from 72 to 93%. Among the associations between the job stress factor and safety climate dimensions, the job stress and worker's safety priority and risk non-acceptance (0.19) had the highest mean influence value. CONCLUSION: The adverse effect of high job stress conditions on accident occurrence is twofold. It can directly increase the accident occurrence probability and in another way, it can indirectly increase the accident occurrence probability by causing the safety climate to go to a lower level.

The relations of job stress dimensions to safety climate and accidents occurrence among the workers.

Based on a literature review, likely, there is a relationship between job stress and safety climate, and in this way, the accident occurrence is affected. Therefore, the present study was aimed to investigate the relations of job stress dimensions to safety climate and accidents occurrence among the workers using regression models. This cross-sectional study was carried out on 1530 male employees in 2019. People were randomly selected from various departments. The participants filled out the questionnaires, including demographical information and accident history questionnaire, the NIOSH generic job stress questionnaire, and the Nordic safety climate questionnaire. In addition, information on occupational experience and accident history was obtained from the health unit of the petrochemical company. In the end, data were analyzed using statistical tests of bivariate correlation, multivariate correlation, and logistic regression. Based on the bivariate analysis, the variables of job satisfaction (0.998), problem at work (0.900), depression (-0.836), and physical environment (-0.796) among the job stress dimensions had the highest correlation coefficients with the total score of the safety climate, respectively. The results of the logistic regression analysis with the adjustment of the effect of the safety climate indicated that the relationships between the dimensions of the job satisfaction (Wald = 6.50, OR = 4.96, and p-value<0.05) and social supports (Wald = 5.88, OR = 3.20, and p-value<0.05) with the accident occurrence were significant. To increase the positive safety climate and decrease the accident occurrence, industries must try to reduce job stress in the workplaces through controlling the important factors, such as low job satisfaction and poor social supports.

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran's position?

OBJECTIVES: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran-despite achieving some of the MDGs-need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries. METHODS: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated. RESULTS: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children. CONCLUSIONS: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

Analysis of affecting factors on patient safety culture in public and private hospitals in Iran.

BACKGROUND: Patient safety culture is one of the main components of the quality of health services and is one of the main priorities of health studies. Accordingly, this study aimed to determine and compare the views of healthcare staff on the patient safety culture and the impact of effective factors on patient safety culture in public and private hospitals in Tehran, Iran. METHODS: This cross-sectional study was carried out on a sample of 1203 health care workers employed in three public and three private hospitals in Tehran, Iran. Stratified random sampling was used in this study. Data were collected using the Maslach burnout inventory and patient safety culture questionnaire (HSOPSC). IBM SPSS v22 and Amos v23 were used to perform path analysis. RESULTS: Eight hundred sixty-seven (72.57%) females and 747 (27.43%) males with a mean age of 33.88 ± 7.66 were included. The average percentage of positive responses to the safety culture questionnaire in public and private hospitals was 65.5 and 58.3%, respectively. The strengths of patient safety culture in public hospitals were in three dimensions including non-punitive response to errors (80%), organizational learning-continuous improvement (79.77%), and overall perceptions of patient safety (75.16%), and in private hospitals, were three dimensions including non-punitive responses to errors (71.41%), organizational learning & continuous improvement (69.24%), and teamwork within units (62.35%). The type of hospital and work-shift hours influenced the burnout and patient safety questionnaire scores (P-value < 0.05). The path analysis results indicate the fitness of the proposed model (RMSEA = 0.024). The results showed a negative impact of a work shift (ß = - 0.791), occupational burnout (ß = - 0.554) and hospital type (ß = - 0.147) on the observance of patient safety culture. CONCLUSION: Providing feedback on errors and requirements for the frequent incident reporting, and patient information exchange seem necessary to promote the patient safety culture. Also, considering the negative impact of the shift work and burnout on patient safety culture, by planning and managing these factors appropriately, correct actions could be designed to improve the safety culture.

Can the BASNEF Model Help to Develop Self-Administered Healthy Behavior in Iranian Youth?

BACKGROUND: The stage of youth is critical for human development in several ways. On the one hand, it can lead people towards the adoption of a healthy lifestyle during adulthood based on these earlier practices. On the other hand, it can comprise the development of healthy living practices later on in live, an outcome which is often caused by the youth adopting a risky lifestyle early on. OBJECTIVES: The primary objective of this study was to determine the effectiveness of implementing an educational intervention program based on the BASNEF Model (a simplified approach to understanding behavior), designed to cultivate self-administered lifestyle control skills in youths. MATERIALS AND METHODS: This was a quasi-experimental intervention study, implemented during 2010 - 2011. A total of 288 randomly selected high-school students between the ages of 15 and 17 participated in this study. These students were later divided into experimental and control groups. Subjects completed a BASNEF questionnaire at the baseline (pre-test), one month later (post-test) and three months after the educational intervention (follow-up). Four educational sessions were held, each of a 120 - 150 minute duration. After the data had been collected, the ANOVA test was used to compare trends in changes. The Pearson correlation coefficient was then used to analyze the correlation between components of the BASNEF model. Finally, regression analysis was used to determine the predictive power of the study. RESULTS: Results from the intervention study reveal that the beliefs and attitudes about nutrition of the intervention group, calculated in terms of scores, improved significantly for both male and female subjects (P < 0.001) as compared to the control group. The mean BASNEF scores for improvements in beliefs among girls and boys were 79.2% and 70.1%, respectively and for attitudes, 61.2% and 59.4%. The increase was significantly higher in the intervention group (P < 0.001). Furthermore, participation in physical activity was more frequent among members of the intervention group than among those in the control group (P < 0.001). CONCLUSIONS: The BASNEF model could be effective in encouraging the adoption of nutritious eating habits and more active lifestyles at an early age in order to foster long-term health and well-being.