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Showing 34 results for Saber

S.a.f Tabatabai, Z Hussain Khan, H Saberi,
Volume 9, Issue 4 (2-1996)

The entity of "neurogenic hypertension" is defined as arterial hypertension caused explicitly by derangement of the intricate network of the central nervous system. Among 193 cases of cranial rhizopathies operated on between 1984 and 1995 at this center, 5 cases of established arterial hypertension with concomitant rhizopathies also underwent ventrolateral medullary decompression. The elevated blood pressure showed an incredible decline, reaching normal values after vascular decompression. The systolic blood pressure however showed a much greater fall than the diastolic component. An endeavour is made to throw light on the cases operated on with special emphasis on the central nervous system as an etiological factor to explain the cause of essential hypertension.
M Saberi-Firouzi, F Kaffashian, E Hayati, Aa Ghaderi, H Keshavarz, S Arshadi, C Arshadi, Mse Sotudehmaram, Ms Massarrat, Ma Ghalambor,
Volume 12, Issue 2 (8-1998)

In order to assess the prevalence of Echinococcus granulosus (EO) infection (hydatidosis) in nomadic tribes of southern Iran, 1000 individuals from a total population of 1 12,519 were selected by randomized single blind cluster sampling method and studied from 1994- 1995. The study included: ( l ) a physical examination by a gastroenterologist, (2) abdominal ultrasonography (US), and (3) detection of anti-EO-antibodies (EOA) by an enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE). The statistically significant prevalences were: US: 1.8%, eIE: 6.8%, and ELISA, 13.7%. The rate of infection varied with age, sex, education, occupation, life style, geographical location of tribal subgroups and the frequency of contact with dogs and cattle. The power of agreement between a combination of each two methods were significant as determined by kappa statistics method. The results obtained indicated that a combination of ELISA and CIE was the most reliable method with a high sensitivity and specificity.
M Rezayat, M Omidi, M Ramazani, M Karami, H Saberi, A Bakhtiarian,
Volume 12, Issue 2 (8-1998)

Paraquat (PQ) is a widely used herbicide. However, a large number of cases of accidental or suicidal poisoning from PQ has been reported. Membrane damage induced by lipid peroxidation, inactivation of protein or damage to DNA by radical formation have been suggested as toxicity mechanisms of PQ. In the present work, the effects of atropine, propranolol, procainamide and dipyridamole on PQ-induced intoxication have been studied. Oroups of male albino mice were used under standard conditions. All the drugs were injected intraperitoneally in different doses. The results indicated that administration of PQ (40 mg/kg, i.p.) increased the death rate of animals (77%) during 3 days, whereas a dose of 20 mg/kg of PQ only decreased the lung tissue total protein and glutathione (OS H) content. This poison also produced serious histopathologic changes in lung tissue. Administration of propranolol ( 10 and 20 mg/kg), procainamide (20 and 40 mg/kg), dipyridamole (30 and 60 Mg/kg) and atropine (5 and 10 mg/kg) decreased the PQ (40 mg/kg)-induced mortality rate in the pre- or post-treatment regimens. These drugs were also effective in reversing the PQ-induced alteration in the lung tissue protein and OSH content, however the pathological findings attenuated in the treated animals. Although the exact mechanism of these drugs against paraquat-toxicity in mice is still unknown, it appears that some of the drugs used may be effective in reversing PQ-induced poisoning in mice and possibly their effects are related to the inhibition of membrane lipid peroxidation via different mechanisms.
Hassan Fallah Husaini, Mansuri Saberah,
Volume 13, Issue 2 (8-1999)

The present investigation was undertaken to evaluate the effect of antihypertensive drugs on aortic atherogenesis in hypercholesterolemic rabbits. In enalapril and nifedipine treated rabbits aortic atherosclerotic plaque involvement was significantly decreased (p<0. Oland p
Seyed Ali F. Tabatabai, Hooshang Saberi, Masoud Mehrazin,
Volume 14, Issue 1 (5-2000)

Reported here are two cases of delayed postsurgical brucella abscess within the cranium, treated successfully by reoperation and appropriate medical therapy. Both patients had an occupational exposure to the pathogenic organism. Systemic symptoms of brucellosis became manifest postoperatively in case I and were present in case II long before operation. The diagnosis was confirmed by serology and positive culture. Later an intracranial abscess developed in both cases at the previous operative sites. Hematogenous spread of bacteria to the locally low resistance host tissue was speculated as the possible mechanism. Successful management was accomplished by reoperation, comprised of local drainage and debridement followed by a combined anti brucella drug regimen for a period of 6 months.
J Bakhtiari, F Saberi-Afshar, H Noorbala, Mj Gharagozlo, A Veshkini,
Volume 14, Issue 3 (11-2000)

The use of bovine amnion in the urinary tract for reconstructive purposes following ablative surgery in cases of trauma, cancer or infection is now a common practice in urological surgery. To evaluate urinary bladder reconstruction with bovine amniotic membrane (BAM), ten healthy mongrel dogs of either sex weighing 10-40 kg were used. The animals were randomly divided into two groups of five animals each. A piece of the cranial wall of the bladder 5 cm in diameter was resected and replaced with fresh and formalin-preserved BAM respectively. The graft compatibility was evaluated on the basis of clinical, biochemical ultrasonographical, radiological and histopathological changes. Clinically all of the dogs were dull and depressed with blood tinged urine for the first few post-operative days. The biochemical parameters didn't show any significant changes in BUN and creatinine. Ultrasonographic findings consisted of floating masses in the bladder lumen (40%), chronic cystitis (10%), bladder adhesion with adjacent tissues (90%) and radiological findings were lack of normal distension of the graft site (100%) and filling defect (30%). No inflammatory responses and leakage were observed. The regeneration of uroepithelium, and proliferation of granulation tissue, infiltration of lymphoid cells, degenerative changes at the junction of the bladder and graft and heterotopic bone formation were observed. Keeping in view the compatibility of the fresh and preserved BAM, this study showed that it can act as a scaffold for repairing urinary bladder defects in dogs.
M Keyhani, H Saberi, H Ahmadieh,
Volume 14, Issue 3 (11-2000)

Forty patients with cataracts, as well as 40 patients with proven ocular toxoplasmosis were enrolled in this prospective clinical study. Serum IgG and aqueous IgG in both groups were measured by enzyme-linked immunosorbent assay (ELISA) and the corresponding ratios were calculated. Serum IgG/aqueous humor IgG ratio was less than 100 in the patient group and more than 100 in the control group. On the other hand in the chorioretinitis subgroup the ratio was less than 13, while in the group With uveitis, the ratio was more than 13 (p<0.05). The results revealed that calculating the ratio of Serum IgG (antitoxo) / Aqueous IgG (antitoxo) may be helpful as an adjunct to diagnosis in cases with clinically atypical ocular toxoplasmosis.
H Saberi, I Jahanzad, Z Hussain Khan, N Saffarian,
Volume 14, Issue 4 (2-2001)

Paragangliomas are extra-adrenal counterparts of pheochromocytomas and are found at various anatomical sites such as the retroperitoneum, mediastinum, jugular foramen and carotid bifurcation, the latter two fonns being coined as chemodectomas. The vertebral column, especially the llUllbar zone, is one of the rarest sites to be involved by paragangliomas. These lesions may have secretory functions and produce symptoms and signs mimicking cathecholamine oversecretion as was noticed in our case. A 60-year-old woman with a sacral mass, backache, and cauda equina syndrome along with arterial hypertension is being presented who had been managed with antihypertensive medications. Magnetic resonance imaging revealed involvement of sacral canal and L5 and S 1 bodies producing a soft tissue bulge near the right buttock and computed tomography showed a destructive sacral lesion. Surgery was performed to resect the turnor mass and surprisingly the postoperative blood pressure reached the normal range and henceforth antihypertensive therapy was withheld. Tissue diagnosis of paraganglioma was made on the basis of histopathological examination and ascertained by immunohistochemical study for chromogranin, neuron specific enolase, synaptophysin and S 1 00 protein. One month later the tumor site was subjected to radiation for any remnants following surgery. After two years, the patient was found to be doing well and had been normotensive Without medications. Spinal paragangliomas are treated with total excision and irradiation for residual tumor, if present. The role of immunohistochemistry could not be overemphasized for diagnostic confirmation.
Z Hussain Khan, H Saberi, Ma Bitaraf,
Volume 16, Issue 4 (2-2003)

Both midazolam and thiopental sodium are being used as induction agents and for maintenance of anesthesia. In contrast to other benzodiazepines such as diazepam, midazolam has a rapid onset of action and fast distribution and causes few cardiovascular or respiratory effects. Being water soluble, midazolam is also associated with a low incidence of venous irritation. The purpose of this study was to see whether midazolam is a suitable substitute for thiopental sodium as an induction agent. To compare the hemodynamic changes associated with midazolam and thiopental sodium as induction agents, this study was conducted in two groups each comprising of 30 patients. No significant hemodynamic changes regarding heart rate and blood pressure could be noticed in the two groups (p<0.05). All patients in the midazolam group exhibited anterograde amnesia but in the thiopental group, 20% of the patients had recall for operative events one hour after completion of surgery. To arrive at more conclusive results, preferably multi-center studies involving large numbers of cases are recommended.
M.r. Kalantar Motamedi, M. Rezaei, P. Kharazm, M. Sharifi, A. Kavyani, M. Zeynal Zade, A.r. Saberi,
Volume 20, Issue 3 (11-2006)


 Background: The loop colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion. We are introducing the use of a full thickness skin bridge under the large bowel instead of a glass rod which alleviates problems such as protrusion of the large bowel, retraction of the bowel into the abdomen after removing the rod and hindering proper application of a colostomy bag over the stoma.

 Methods: Seventeen patients needing double barrel colostomy for complete diversion of fecal material were selected using loop colostomy with skin bridge. Three patients had Fournier's gangrene and 14 had penetrating rectal injury. Omega loop colostomy with a full thickness skin bridge was performed for fecal diversion.

 Results: All of the 17 patients had gas passing and full passage of fecal material within 3 days postoperatively. No case of skin necrosis and stitch abscess was encountered. No parastomal hernia or large prolapse was noted until healing was completed and patients were discharged and after at least 8 weeks and in Fournier's gangrene somewhat longer, the loop colostomy was closed without the need for formal laparotomy and without any case of anastomotic leak.

 Conclusion: In this study we confirmed that diverting loop colostomy using a skin bridge is a safe, rapid and easy to manage colostomy technique which gives complete diversion similar to double barrel colostomy without the need of performing a laparotomy for closure of the colostomy.

M.r. Kalantar Motamedi, A. Saberi, H. Khajooei Kermani, M. Aminseresht, A. Kavyani, M. Talebian, M. Akbari,
Volume 21, Issue 3 (11-2007)


 Background: End-to-side esophagojejunostomy has almost always been associated with some degree of dysphagia. To overcome this complication we decided to perform an end-to-end anastomosis and compare it with end-to-side Roux-en-Y esophagojejunostomy.

 Methods: In this prospective study, between 1998 and 2005, 71 patients with a diagnosis of gastric adenocarcinoma underwent total gastrectomy. Standard esophagojejunostomy with an end-to-side fashion was performed in 41 patients and compared with our recommended technique of end-to-end esophagojejunostomy in 30 patients.

 Results: This study showed that esophagojejunostomy with an end-to-end fashion has a low incidence of postoperative dysphagia (33.3%), whereas in those with an endto- side anastomosis the rate of ysphagia is very high (83%).

 Conclusion: A Roux-en-Y esophagojejunostomy with an end-to-end anastomosis has a low incidence of postoperative dysphagia and we strongly recommend using this technique.

A. Afsharfard, M . Mozaffar, H. Vafaei, A. Kavyani, A. Saberi, M. Zeinalzadeh, M. Sharifi,
Volume 21, Issue 4 (2-2008)


 Background: There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence.

 Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned.

 Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy 2 had a positive DPL and negative laparotomy 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy.

 Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

Yasser Labbafinejad, Saber Mohammadi, Mirsaeed Attarchi, Mashallah Aghilinejad,
Volume 24, Issue 2 (8-2010)


  Background : Noise is the most common hazard in the workplace and noise induced

  hearing loss considered to be the most common occupational disease as well.

  Cigarette smoking, in some studies, has been known to induce hearing loss. The purpose

  of this study was to evaluate the effect of contemporary exposure to occupational

  noise and cigarette smoking on hearing.

  Methods : 478 assembly workers of an automobile plant which were exposed to

  the noise more than TLV (threshold limit value) level included in this study. After

  considering the exclusion criteria, all participants according to the smoking status

  were divided in smoker and nonsmoker groups and compared for hearing impairment.

  Hearing impairment in this study was assessed with the offered method of

  American Academy of Otolaryngology (AAO).

  Results : Of 478 assembly workers, 225 persons were smokers and others non

  smokers. Prevalence of hearing impairment in smokers was significantly higher

  (p<0.001). Hearing impairment had a significant relation with smoking status even

  after adjusting for cofounders like age and duration of work (OR=8.23, 95%


  Conclusion : The results of this study suggested that cigarette smokers had more

  hearing impairment than non smokers. According to these results we concluded that

  in working environments, especially in noisy ones, workers must be encouraged to

  quit smoking and regular audiometric tests, especially for smokers, must be applied.

  We must consider not only the noise, but indeed all effective elements of hearing impairment

  in working environment that could compromise the hearing.


Reza Shariat Moharari, Saber Amin Zade, Farhad Etezadi, Atabak Najafi, Mohammad Reza Khajavi, Mohammad Shirani Bidabadi, Hadieh Moradi Tabriz,
Volume 27, Issue 1 (Published 28 February 2013)

 Background: Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient.


Methods: After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups.

 Results: No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (P < 0.001).


Conclusion: The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.

Yasser Labbafinejad, Saber Mohammadi, Elham Mirzamohammadi, Mostafa Ghaffari, Mirsaeed Attarchi, Azadeh Amiri,
Volume 28, Issue 1 (1-2014)


Background: Organic solvents are known as a group of organic compounds, widely used in industry and to which many workers are exposed. Neurotoxicity is one of the most important complications of the chronic exposure to the solvents and may causes neurobehavioral disorders in workers. We have studied the frequency of neurobehavioral disorders in workers exposed to organic solvents in one of the publishing houses in Tehran.


Methods: In this cross-sectional study, 510 workers of a publishing house, having been employed at least a year before the research, were selected to be studied. Among them, 345 workers had been exposed to organic solvents and the other (165 workers) had not. Data were collected using a questionnaire. This questionnaire included demographic and occupational information, and the Swedish Q16 questionnaire. Variables included age, duration of employment, working shift, and smoking. Then we compared both groups in terms of neurobehavioral disorders, using statistical methods.


Results: The mean score of the Swedish Q16 questionnaire in the exposed group (4.8±4.4) was significantly higher than the non-exposed group (3.2±3.1) (p=0.001). According to the questionnaire score, the frequency of neurobehavioral disorders in the exposed group was 38% and in the non-exposed group was 22% (p=0.001). We estimated that the frequency of neurobehavioral disorders in the exposed group was significantly higher than the non-exposed group (p<0.05) using regression analysis and removal of the confounding factors.


Conclusion: This study shows that the frequency of the neurobehavioral disorders in the exposed group is significantly higher than the non-exposed group.

Mahdie Golchin, Mirsaeed Attarchi, Elham Mirzamohammadi, Mostafa Ghaffari, Saber Mohammadi,
Volume 28, Issue 1 (1-2014)

 Background: Severe upper extremity injuries can affect the quality of life in patients and cause multi-factorial and long-term costs of disease. The aim of this study was to assess quality of life in patients with upper extremity injuries caused by work-related accidents.

 Methods: In this study cross-sectional method was used in patients referred to the Occupational medicine Clinic of Rasoul Akram Hospital to determine their impairments. Patient's information including demographic variables, calculation of the impairment rate based on AMA Guide book (in terms of WPI), returning to work, and location of injury, work experience and type of injury. Then the quality of their life was assessed and interpreted using SF36 questionnaire.

 Results: 203 patients were evaluated. Different aspects of the patients’ life were not associated with age, gender and education of patients based on The SF-36 questionnaire. There was an inverse relationship between the percentage of patients’ impairment and different aspects of life quality there were also a significance correlation between impairment rate and physical performance of patients (p<0.001, r= -0.26), social performance of patients (p= 0.001, r= -0.24), pain (p= 0.005, r= -0.2), emotional health of patients (p= 0.006, r= -0.29), energy / fatigue in patients (p<0.001, r= -0.29) and the patient's general health (p<0.001, r= -0.27).

 Conclusion: This study shows that upper extremity impairment due to occupational injuries has an inverse and significant association with various aspects of quality of life.

Mohsen Saberi Isfeedvajani, Ali Akbar Karimi Zarchi, Abbas Musavi Heris, Fatema Sajjadi, Ali Mehrabi Tavana,
Volume 28, Issue 1 (1-2014)

  Background : Hypertension is a risk factor for life threatening diseases such as cerebrovascular accidents, coronary artery diseases, congestive heart failure and chronic renal failure. The prevalence of non-communicable diseases such as hypertension and diabetes including obesity has increased over the past few years in Iran. The first step for modification of cardiovascular diseases in a defined population is to assess the prevalence of their risk factors. This study was conduceted to assess personnel blood pressure and its risk factors in one of the medical universities of Tehran in the Health Day of 2013.

  Methods : This cross sectional study was performed from May 19, 2013 to May 24, 2013 (I.R. of Iran’s Health Weak) in one of the medical universities of Tehran. Participants completed voluntarily a researcher-made questionnaire which composed of demographic characteristics and variables about risk factors and preventive factors of cardiovascular diseases such as smoking, history of diabetes, history of hypertension, physical exercise status and so on. Blood pressure was measured by mercury sphygmomanometer and weight and height were measured by a ground analogue scale.

  Results : Of 195 persons participated in this study, 180 persons (92.3%) were male. The mean age of participants was 33.75 (±9.87) yr. The mean of systolic and diastolic blood pressure was 114.44 (±8.67) mmHg and 73.06 (±8.45) mmHg, respectively. The prevalence of overweight, obesity, prehypertension and hypertension was 41.7%, 17.8%, 40.4% and 11.7% respectively. Only 8 persons (5.6%) were cigarette smokers.

  Conclusion : Despite the low prevalence of hypertension in our samples, the high prevalence of pre-hypertension and overweight need great attention. Interventions like life style modification could be effective in prevention of hypertension.

Fariba Almassinokiani, Alireza Almasi, Peyman Akbari, Mahboubeh Saberifard,
Volume 28, Issue 1 (1-2014)

  Background : To determine the role of Letrozole, an aromatase inhibitor,in the treatment of endometriotic pain.

  Methods: In this prospective, randomized, controlled clinical trial in minimallyinvasive surgery research center,51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously.

  Results: Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant.

  Conclusion: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome.


Yasser Labbafinejad, Mostafa Ghaffari, Baharak Bahadori, Saber Mohammadi, Alireza Abdi, Mohamad Namvar, Mirsaeed Attarchi,
Volume 28, Issue 1 (1-2014)

  Background :Work ability assessment and its affecting factors are important in the field of occupational health. One of the factors affecting work ability is sleep disorder, which is very common among workers. Therefore, the present study aimed to assess work ability and its relationship with sleep disorder in workers of a manufacturing plant.

  Methods : This cross- sectional study was conducted in a manufacturing plant in Tehran in 2013. All the 931 male workers of this plant were enrolled in the study, and their work ability was assessed using the Work Ability Index (WAI). The scores of this index range from 7 to 49, and the higher work ability score indicates a better work ability status. In this study, sleep disorder was assessed using the MUSIC-Norrtalje Questionnaire.

  Results : The average score of WAI was 42.81, ranging from 22 to 49. This score was significantly lower in the group with sleep disorder (41.28) than in the group without sleep disorder (44.10) (p< 0.001). The results of the logistic regression analysis revealed a significant relationship between work ability and sleep disorder even after adjustment for the confounding variables (OR= 2.52, 95% CI= 1.07 – 5.93, p= 0.033).

  Conclusion : The results of this study found a relationship between sleep disorder and work ability. Therefore, it is recommended to identify workers with sleep disorder and attend to their problem in order to increase their work ability.

Aziz Rezapour, Farbod Ebadifard Azar, Saber Azami Aghdash, Asghar Tanoomand, Nahal Ahmadzadeh, Ali Sarabi Asiabar,
Volume 29, Issue 1 (1-2015)

Background: Health inequalitymonitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-of-pocket health carepaymentsin Tehran metropolis.

Methods: This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality wasused for measuring inequality status in capacity to pay and household payments for health care expenses and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient.

Results: The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US$ and for each inpatient1861.11 US$. Concentration index for household's out-of-pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments werecalculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household’s capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures.

Conclusion: According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household’s capacity to pay through government support in order to improve the household economic potential, must be considered very important.

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