Social Determinants of Health

The World Health Organization introduced social responsibility for the medical universities centered on education, research and provision of services. This definition states that social responsibility is "obligation of the medical schools to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve, The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public"(1).

Using the above definition as a model, Iran's medical universities were expected to think about socialization of health much earlier than what actually recently happened. However, what has occurred in relation to community-oriented medicine in Iran over the last quarter century has mainly been focused on increasing community access to specialized medical services and hasty implementation of the family physician program in rural areas and some cities.

Clearly, socialization of health is not possible with merely setting up a social deputy in the body of the Ministry of Health and Medical Education. Socialization of health means communal involvement in maintaining and promoting individual, social, and psychological health of the community, and this will only be achieved through community-based medical education that not only trains skilled and competent human resources, but also focuses on empowerment of the community, or in another sense, promotion of community health. In other words, it is necessary to consider social responsibility as a principle in the excellence of medical education (2).

Indeed what percentage of Iranians actually take part in decision-making about health? What percentage of the general public in Iran are addressed by articles published by medical universities' experts? To what extent contents of the medical universities' portals cover requirements of the general community? What is universities' approach to community empowerment? Moreover, the bigger question is whether Iranians know what their own health requirements are.

As much as a responsible medical university is concerned about professional competence and professionalism of its graduates, it should look at improving health literacy of the community it covers. Such a university does not confine education to the enclosure of the university, but addresses education of the community at three levels: Generic, Targeted, and Tailored. Graduates from a responsible university know that community health can be ensured only by increasing health literacy of the community, and even their participation in the field of health research known as community-based participatory research. Although increasing access of different strata of the community to health services and providing the highest quality of services are worthwhile per se; these are not sufficient for community to encounter and cope with health-threatening factors.

A responsible university responds to the ever-changing community needs, and to this end, takes advantage of a surveillance system that is able to quickly identify new community needs and finding support to resolve these needs (3).

A responsible university collaborates with other organizations and institutions, general community, other professional groups, policy-makers and even statesmen, and that is how it can conduce the system of continuous provision of health services (3).

In addition, a medical university formed on the bases of social responsibility will undoubtedly put health promotion and diseases prevention on top of its agenda (4). The fact that despite quantitative progress of medical universities in recent decades, some simplest health hazards are still not easily prevented, this means that responsiveness and accountability are neglected by most Iran's medical universities.

Although in recent years, indicators of social responsibility of medical universities have been defined (5), and even highlighted in the last transformation of Iran's medical education, there seems to be a long way to achieving the ultimate goal of social accountability. 

  Background: Early and delayed marriage has their own effects on mothers and their children's health and social dimensions. Nowadays, Iran experiences delayed marriage due to several factors; thus, the present study was concocted to investigate the factors affecting youths’ marriage age, and to compare these factors between males and females.

  Methods: To study demographic, socio-economical, and some atitudinal behavior factors affecting the age of marriage, in the current cross-sectional study, 12741 Iranian pre-married youths including 6381 males and 6360 females from all provinces were selected using multi-stage stratified method and the data was collected using a structured questionnaire in 2014. The questionnaire included demographic, socio-economical, and some atitudinal behavior questions about childbearing. Kaplan-Meier, Log-Rank test, and parametric survival analysis were applied in IBM SPSS Statistics for Windows, Version 22.0., and SAS 9.3 software.   

  Results: Gamma and Log Logistic parametric models were the best fitted models for females’ and males’ marriage age, respectively. Females and males who lived in provinces with TFR<2 were married α=0.03 (95%CI=0.02_-0.05) and α=0.05 (95%CI=0.04_0.06) times later than those who lived in provinces with TFR 2, respectively. Rural females and males married α=-0.06 (95%CI=-0.08_-0.03) and -0.02 (95%CI=-0.06_-0.03) times sooner than urban ones, respectively. As educational level, the number of siblings, and income increased, the youths’ marriage age increased (P<0.05). Employed youths also married later compared with unemployed ones.

  Conclusion: Young females and males had the same factors influencing their marriage age.

  Background: Stroke is the second common cause of death in the world. It imposes a huge amount of economic and social burden on individuals, families, communities, and governments. There are significant regional differences in stroke incidence even within countries. The last information about stroke incidence in Bushehr is related to 2002-2003. Life expectancy is increasing and as a result burden of non-communicable diseases including stroke is in progress, so the current study was conducted to obtain a better picture of stroke incidence in Bushehr district, Iran, in 2013-2014.

  Methods: In a retrospective cohort study, hospital files of all the individuals admitted as stroke or transient ischemic attack in the Persian Gulf and Salman-e-Farsi Hospitals in 2013-2014 were studied. A list of patients with diagnosis of stroke was prepared using International Classification of Disease 10. Bushehr middle year population was estimated based on the census (2011-2012). Age standardization was done according to World Health Organization standard population. Incidence correction was done using sensitivity analysis.  

  Results: In the study year, 255 cases of stroke were registered in two hospitals. The mean age was 65.3±14.14 years. Crude and standardized incidence of stroke were 92.71 (81.69-104.81) and 198.3 (189.68-207.22) per 100,000, respectively. Standardized incidence was higher in men as compared with women (P<0.001).

  Conclusion: Stroke incidence is high, especially in men, in Bushehr district. A population-based stroke registry is necessary for more accurate estimation of the rates over time.

  Background: Emotional intelligence is a set of teachable abilities and skills that prepare people for the sustainability and success in life. The purpose of the present study was to predict the emotional intelligence based on metacognitive beliefs and mindfulness beliefs in the students.

  Methods: A total of 341 students were selected from Islamic Azad University, West Islamabad branch, using random cluster sampling from different university majors at the faculty of Social Sciences. They responded to Bar-Anne's Emotional Intelligence Questionnaire, the short form of the Wells Meta-Cognition Questionnaire, and Baer et al. Mindfulness Questionnaire. Data were analyzed using Pearson correlation coefficient and stepwise regression.   

  Results: Among the participants 200 (67.5%) were girl students. the age of the participants ranged between18 and 52 years old. Also 254, (78%) had Bachelor’s degree and 87 (21.97%) had Master’s degree. Moreover, 105 (77.33%) were married. The mean (SD) of mindfulness were 107.3 (5.12), meta-cognitive beliefs 47.8 (5.01), and emotional intelligence 85.9 (13.43), respectively. The results of regression analysis showed that metacognitive beliefs were independent predictor of students' emotional intelligence (P<0.001, F=34.59). Metacognitive beliefs predicted a total of 21% of students' emotional intelligence.

  Conclusion: Considering the findings of the present study, it can be stated that more attention should be paid to metacognitive beliefs as an independents predictor of emotional intelligence.

Background: Melamine is an organic base material whose resin is used to prepare the food-related wares. The initial migration of melamine from tableware to food can be for the remained monomers, but the secondary migration is an important concern for breakage and damage of polymers. Previous studies showed that acidity, temperature, and time have effects on melamine migration. The present study was conducted to measure melamine migration from melamine-wares to food and to investigate the effects of temperature and time on migration using HPLC method.
Methods: Melamine-wares were purchased according to Iran National Standard guidelines. Four various tests were designed to examine the effects of time and temperature on melamine migration to the Acetic acid 3% as a food simulant. Exposures were done at temperatures 30 and 90 ◦C for 30 and 90 minutes. Migration was determined using HPLC method.
Results: In all samples, migration occurred but it was lower than the Specific Migration Limit (SML). Melamine was restricted by SML of 30 mg/kg (European Union standard). Findings indicated that the temperature and time had significant effects on migration. Temperature had specially a direct relationship with melamine migration.
Conclusion: Findings of the present study indicated that the independent variables, including temperature and time, had significant effects on migration, so precautions should be considered when using melamine wares for hot and acidic foods.

Background: Health Promoting Behaviors (HPB) are of great importance because of their potential benefits to prevent the progression of chronic diseases, reduce disease burden, improve quality of life, and reduce healthcare costs. The present study aimed to determine and compare HPB and related factors among high school teachers.
Methods: A cross-sectional study was conducted on 257 high school teachers (138 women and 119 men) having at least associate degree in Rasht city, Iran during 2015. Data collection tool was a researcher-made questionnaire including the personal, familial, and social factors and Health-Promoting Lifestyle Profile (HPLPII) standard questionnaire. Data were analyzed using IBM SPSS Statistics for Windows, Version 24.0. running descriptive and inferential statistics, including independent sample t-test, analysis of variance. P values less than 0.05 were considered as statistically significant.
Results: Among the participants 138 (53.7%) were female. The overall mean (SD) score of HPB among participants was 129.6 (22.64) and was undesirable. This score was significantly better among the women 130.6 (24.61) compared with men 128.5 (20.54) (P=0.01). The highest mean score of HPB was related to nutrition 26.8 (5.01), followed, respectively, by spiritual growth 22.6 (4.25) and interpersonal relations 21.7 (4.82). Physical activity with the mean (SD) score of 18.09 (4.14) had the lowest overall mean score of HPB. Female teachers had a significantly higher scores than men in all aspects (P<0.05), except for physical activity and stress management.
Conclusion: The overall mean score of HPB among participants was undesirable. Total HPB in female teachers were better than that in the male teachers. Female teachers had a better status than men in all aspects except for physical activity and stress management.

Background: Prostate cancer is the fourth most and one of the most prevalent cancer in worldwide and Iran respectively. that has both environmental and genetic risk factors. Recently, the role of sexual activity has been considered as a possible risk factor. We conducted this study to evaluate the role of sexual activity in prostate cancer

Methods: This case-control study enrolled 120 patients, 59 with prostate cancer and 61 with other urologic conditions in the Urology Ward of Shahid Beheshti Hospital, in Hamadan, Iran in 2016. We used an individual matching technique to control for confounders (age, weight, etc). A self-structured questionnaire was used to gather required informations such as sexual habits of the participants. Finally, data were analyzed with SPSS 16.

Results: The mean sexual activity (per week) for the last 5-10 years was 1.78±1 in the case group and 1.6±0.2 in the control group (P=0.26). Participants exhibited different sexual patterns during different age strata: at age 71-80 years and >80 years the sexual activity in 5-10 years before diagnosis (days per week) in case group was more significant than control group respectively P=0.001 and P=005 also sexual activity (days per week) at age 71-80 years in one year before diagnosis was more significant in case group in comparison with control group (P=0.033).

Background: Health Maintenance Organization (HMO), were once viewed as the most cost-effective model for achieving such efficient high-quality health care. A decade after the decline of HMOs a similar idea evolves and continues to proliferate under the rubric of Accountable Care Organizations (ACOs).

Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify the reasons for the decline of HMOs, with the ultimate goal of extrapolating findings from HMOs experiences onto ACOs. We searched PubMed, Web of Science, and EMBASE to select original research and reports related to the decline of HMOs in the U.S. Using organizational evolving theory the contents of selected studies were analyzed and categorized according to common characteristics.

Results: Although the decline of HMOs varies somewhat from case to case, it follows a fairly consistent pattern with similar causes. These factors were related to wrong ethos, mismanagement, failing to control costs, resistance from provider groups, increased competition, and inadequate IT infrastructure leading to patient dissatisfaction. Patient dissatisfaction in turn led to a managed care backlash, which stimulated the enactment of new restrictive legislation. Restrictive legislation not only negatively impacted the continued growth of HMOs but also accelerated the speed of their decline.

Conclusion: ACOs should set realistic goals, align the incentives for physicians and hospitals via shared savings, use non-physician providers such as nurse practitioners, invest on health information technology, practice patient centered approach, make provider and patients accountable, use efficient management methods and improve care coordination.