Social Determinants of Health

How do we know and live old age today? What does it mean to be old in a time of the promise of high-tech medical interventions?  Anthropologists and sociologists address the phenomenon of growing old both as experienced by individuals and their families and by the ways in which older lives are embedded in social, historical and political contexts. In recent decades a multitude of factors ensure that the very ideas of ‘aging’ and ‘health’ in late life are being transformed.  As a result many social scientists have turned their attention to global developments in the spread of biomedical knowledge, the impacts of high-tech interventions on the practice of medicine in an aging world and shifting societal expectations about longevity.  

Background:

The global burden of cancer due to population growth and aging, and various environmental factors is increasing. Skin cancer is the most common cancer among Iranians and among men, is more common. There is strong evidence from Industrialized and less developed countries that cancer incidence and survival is related to socioeconomic factors. The aim of this study was to investigate the relationship between socioeconomic variables including Human Development Index, unemployment rate and Urbanization ratio with the incidence of skin cancer in Iran.

Method:

The panel data were for 30 provinces for 6 years) 2007 to 2012(. Data of socioeconomic factors were collected from the Statistical Center of Iran and the data related to the incidence of cancer were collected from the reports on cancer registry of Health and Medical Education Ministry. For data analysis Stata11th version was used.

Result:

There is no relation between unemployment and the incidence of skin cancer. There is negative relationship between urbanization and incidence of skin cancer in both sexes. There is negative relation between HDI and the incidence of skin cancer in both sexes.

Conclusion:

Among the three variables selected in this study, the human development index and the urbanization, influenced on the cancer incidence. Therefore, in order to prevent skin cancer, paying attention appears to be necessary for policymakers.

Key words: Socioeconomic Factors, Skin Neoplasm, Iran

  Background: Social workers have a responsibility to tackle the social determinants of health which cause health inequities. The hospitals’ social work units have the responsibility to improve patients' physical, mental, and social health. In this regard, understanding patients' demands is essential. The objective of the present study was to determine self-report demands of patients who were referred to social work unit in Taleghani hospital, Tehran.

  Methods: The current cross-sectional study was conducted on the clients who were referred to social work unit of Talghani hospital, Tehran. Data was collected during autumn 2015 using convenience sampling method. Data collection form included demographic characteristics of the participants, the reason for referral to the social worker, self-report demands of the patients, and the response of the social worker to the patients. Data was analysed using IBM SPSS Statistics for Windows, Version 22.0.

  Results: Of all clients who had attended social work unit, 772 accepted to participate in the study (response rate 87.1%). About 43% of the patients were female. Out of 990 requests, about 50% of the clients needed assistance to resolve financial problems. Help for resolving familial and insurance problems were the subsequent demands of the clients. Meanwhile, the most common response given by the social worker to the patients’ demands was financial assistance (n=276) (28.9%), and helping to resolve patient's familial problems (n=107) (11.2%) and offering health insurance services (n=106) (11.1%) were the second and the third most common responses, respectively.

  Conclusion: The present study showed that still we have a long way to meet the aims of social work unit for empowering the patients and their families to withstand difficult conditions following the disease.

  Background: Socio-economic factors, following psychological factors, affect the value of children in parents’ view and this value itself could influence Ideal Number of Children (INC), which is one of the most important dimensions of fertility behavior. The aim of the present study was to investigate parents’ INC according to the factors influencing the value of children from the viewpoint of men and women, separately.

  Methods: In a cross-sectional study, multi-stage stratified sampling method was conducted to collect data from 590 males and 610 females in Tehran province, Iran, using a questionnaire including demographic and attitudinal questions. To describe data, SPSS-17, and to examine the factors influencing INC, path analysis was used in AMOS 22 and Goodness of fitted model was approved using the relative chi-square ( , Goodness of Fit Index (GFI), Adjusted GFI (AGFI), and Root Mean Square Error of Approximation (RMSEA) indices.

  Results: Indices of Goodness of fit confirmed the fitted models ( =2.289, GFI=0.994, AGFI=0.973, and RMSEA=0.047 for males’ model and =0.511, GFI=0.989, AGFI=0.994, and RMSEA=0.020 for females’ model). Negative psychological (males’ coefficient=-0.20 and females’ coefficient=-0.17, P<0.001) and positive economic (males’ coefficient=0.11 and females’ coefficient=0.09, P<0.05) factors of children values were both significant on INC based on gender. Moreover, negative social factor (males’ coefficient=-0.26, P<0.05) of value of children was significant on INC only for males. These significant factors had higher impacts on men's INC, as compared with that of women

  Conclusion: According to the results of the present study, significant factors influencing INC of males and females were negative psychological and positive economic factors of the value of children and the negative social factor of value of children was the only significant factor influencing INC for males.

  Background: Applied Behavior Analysis (ABA) is applicable for children and adults with different psychological disorders, developmental disabilities, and learning disabilities. The goal of the present study was to examine the effectiveness of ABA in the increase of self-help skills and reduction of stereotyped behaviors of children with Autism Spectrum Disorder (ASD) in Isfahan, Iran.

  Methods: this was a quasi-experimental study. The study population included 512 children diagnosed with ASD in Isfahan, Iran during 2015-2016. Using a convenience sampling method, 26 participants were randomly divided into experimental and control groups (13 participants in each group). The study instruments included: the Self-Help Skills Developmental Chart and the Gilliam Autism Rating Scale that were administered at both pretest and posttest. The experimental group received an ABA intervention for 20 sessions (each session: 2 hours) over 3 months. Data analysis was done using IBM SPSS Statistics for Windows, Version 22.0.   

  Results: The results showed that there was a significant difference between autistic children in the experimental and control groups in self-feeding (t=7.01, P=0.01), personal hygiene (t=11.12, P=0.003), mobility impairments and unusual behaviors (t=63.63, P<0.001), verbal and non-verbal behaviors (t=11.58, P<0.001), interaction with people, objects, and situations (t=11.81, P=0.003), and developmental impairments (t=88.28, P<0.001).

  Conclusion: The ABA appears to be an effective method for increasing self-help skills and reducing stereotypic behaviors in children with ASD. Educational psychologists can use behavioral activation therapy to treat the learning problems of children with ASD.

Background: Tobacco smoking has been a major health concern for many years. People's awareness of the potential health hazards and government policies might change its pattern and prevalence of use. In order to monitor its conversion, determining the overall pattern of tobacco use and trend analyses would be crucial, which were aimed in the present study. Methods: Patterns of smoking in four national surveys conducted in years 2000, 2005, 2007, and 2011 with 33300, 89337, 5287, and 8837 participants, respectively, were assessed. Current status of cigarette, pipe and water-pipe smoking, the number of cigarettes used per day, and the age of smoking initiation were major parameters. After weighting based on province, residential area, gender, and age group, trend analysis was done through complex samples general linear model using IBM SPSS Statistics for Windows, Version 20.0. The values in the first survey (2000) were considered as reference points and categories. Results: While current cigarette smoking prevalence has been decreased (13.5% in 2000 to 11.3% in 2011) P<0.001, the average of pack-years increased. There was no significant decline in the mean age of initiation. It is also true for the prevalence of pipe and water-pipe smoking, which showed no noticeable difference compared to 2000. Conclusion: According to our findings it seems that health policy makers should focus more on designing programs targeting water-pipe consumption and also pay attention to the trends among subgroups for tailoring policies and scheme implementation.

  Background: Life skills are the abilities to have adaptive and positive behaviors that enable human beings to deal effectively with the demands and challenges of life. The aim of the present study was to examine the effectiveness of teaching life skills on self-efficacy and emotional intelligence among high school students.

  Methods: A quasi-experimental study was conducted on 462 male high school students of Silvana area in Urmia city, selected via multi-stage cluster sampling method. These students studied in two different schools. Three classes were selected randomly from each high school and all the students of these classes completed the self-efficacy and emotional intelligence inventory. Participants who scored low on effectiveness of life skills training were selected for the study; among them 30 students were selected randomly and assigned randomly into two experimental and control groups (15 students each). The experimental group received life skills education but the control group did not receive any education. Both groups completed the Sherer's Self-Efficacy Scale and Bar-On Emotional Intelligence-Inventory in baseline and follow up phases. The data were analyzed using descriptive statistics (the mean and standard of deviation) and Multivariate analysis of covariance (MANCOVA). Statistical analysis was perfumed using IBM SPSS Statistics for Windows, Version 22.0.

  Results: The results of the study indicated that teaching life skills significantly increased mean±SD scores of self-efficacy (68.2±7.35, 55.4±9.96) and emotional intelligence (106.6±15.05, 94.8±11.33) in the experimental and control group, respectively (P=0.001). there were significant correlations between self-efficacy and academic achievement (r=0.518, P=0.01)

  Conclusion: Teaching life skills can improve students' self-efficacy and emotional intelligence and the education officials should pay attention to teaching these life skills to the students.