Objective: To estimate the economic burden of hemophilia A and B in the patients referred to the related referral hospital in the south of Iran in 2017. Methods: This cross-sectional study was a partial economic evaluation and a cost of illness study, carried out in 2017. All the patients with hemophilia A and B referred to the related hospital affiliated to Shiraz University of Medical Sciences in the south of Iran were included in the study (N = n = 253). A data collection form was used to collect the required data, including patients' direct and indirect costs. Results: The mean annual cost was 36028 USD. The mean costs per patient with hemophilia A and B were 37661 USD and 30775 USD, respectively, in which the greatest part were related to direct medical costs (98.32% in hemophilia A, 98.18% in hemophilia B, and 98.29% of the total costs), and the cost of clotting factor concentrates accounted for the largest share of the patients' direct medical costs. Also, considering the number of hemophilia patients in Iran, the mean annual cost of the patients in 2017 was 414480325 USD, of which 381503701 USD was for hemophilia A and 32976624 USD was for hemophilia B patients. Conclusion: Considering the significant economic burden of hemophilia and in order to reduce the costs, the following suggestions can be offered: provision of clotting factor concentrates domestically in accordance with the world standards, and providing specialized services and care to hemophilia patients in towns.

Voice problems are routinely assessed in hospital voice clinics by speech and language therapists (SLTs) who are highly skilled in making audio-perceptual evaluations of voice quality. The evaluations are often presented numerically in the form of five-dimensional 'GRBAS' scores. Computerised voice quality assessment may be carried out using digital signal processing (DSP) techniques which process recorded segments of a patient's voice to measure certain acoustic features such as periodicity, jitter and shimmer. However, these acoustic features are often not obviously related to GRBAS scores that are widely recognised and understood by clinicians. This paper investigates the use of machine learning (ML) for mapping acoustic feature measurements to more familiar GRBAS scores. The training of the ML algorithms requires accurate and reliable GRBAS assessments of a representative set of voice recordings, together with corresponding acoustic feature measurements. Such 'reference' GRBAS assessments were obtained in this work by engaging a number of highly trained SLTs as raters to independently score each voice recording. Clearly, the consistency of the scoring is of interest, and it is possible to measure this consistency and take it into account when computing the reference scores, thus increasing their accuracy and reliability. The properties of well known techniques for the measurement of consistency, such as intra-class correlation (ICC) and the Cohen and Fleiss Kappas, are studied and compared for the purposes of this paper. Two basic ML techniques, i.e. K-nearest neighbour regression and multiple linear regression were evaluated for producing the required GRBAS scores by computer. Both were found to produce reasonable accuracy according to a repeated cross-validation test.

Background: Management transport occurs in organizational hierarchy commonly; so, succession planning is of a great importance. In this regard, identification of the effective methods for succession planning leads to organizational success in health care systems. This study aimed to identify the dimensions of succession and formulate the components of health network managers' selection. Methods: This qualitative research was conducted by applying the content analysis approach in 2018. To glean the information, 42 semi-structured interviews were conducted using the snowball sampling method. Data was analyzed by framework analysis applying Max QDA 10 software. Results: The main effective factors for achieving the health network administrator management rank contained 4 main themes of managerial education and skills, specified education and skills, educational methods, and performance evaluation mechanism. Moreover, we identified the main applied points in monitoring the health network managers' duties. Conclusion: The basic criteria should be defined  for selecting appropriate people and improving the quality of services. It also can lead to a framework for succession planning and is helpful in organizational decision making improvement.

Background:The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018.Methods:The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the "WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modelling in SPSS 23.0 at the significance level of 5%. Results:The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR=3.14, P-value<0.001), households with disabled members (OR=27.98, P-value<0.001), households with children under 5 years old (OR=2.718, P-value=0.02), and those without supplementary health insurance coverage (OR=1.87, P-value=0.01).Conclusion:CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

The authors have withdrawn this preprint due to author disagreement.