Social Determinants of Health

Background: Infertility is a medical and social status that can cause social, emotional and psychological disturbances in infertile couples. The purpose of this study was to determine the role of social determinants of health among infertile couples.

  Methods: This descriptive cross-sectional study was carried out in 6 months. The participants in this study were infertile couples referring to Tabriz Jahade Daneshgahi Infertility Treatment Center which is one of the referral centers for infertility treatment in northwestern Iran. Self-administered questionnaire with closed questions was provided to the participants using a Likert scale to collect data. The questionnaire included demographic data including age, sex, occupation, place of living, income, history of the cause and duration of infertility and social protection of individuals.  

  Results: The total number of participants was 205, with a mean age of 6.89±33.78 years. In examining the cause of infertility, 66 (39.1%) had male infertility, 48 (28.4%) had female infertility, 54 (32%) had both female and male, and one case (0.6%) with an unknown cause. In different levels of education, the male factor as a cause of infertility in each level was more prevalent, which showed a significant difference only at the level of the bachelor's degree.
In examining the degree of satisfaction with utilizing existing opportunities and facilities in a society based on the income of the participants in the study; all those with the lowest degree of satisfaction belong to the lowest income group of the community.

  Conclusion: Social factors influencing health have greatly influenced the incidence and cause of couples’ infertility who want to have a child.

Background: For sustainable development and resolve complex public health problems, intersectoral collaboration is a necessity. A Memorandum of Understanding (MOU) is one of the tools used to develop intersectoral interactions. In this study, the challenges in the development and implementation of MOUs and propose strategies to overcome these challenges were studied by collecting the views of some stakeholders from other organizations.

  Methods: For identifying challenges and solutions to improve the situation, group discussions were conducted with the presence of representatives from four ministries of Agriculture, Roads and Urban Development, Sports and Youth, and Education and the representatives of the Ministry of Health and Medical Education, who were responsible for preparing MOUs. All sessions were transcript and analyzed by using content analysis method.

  Results: Some challenges were defined according to the development and implementation of MOUs. For better implementation, suggested strategies were: Strengthening the stewardship of intersectoral collaboration, effective and powerful management in monitoring the implementation of MOUs, Determining the appropriate financing path, strengthening individual and organizational capabilities in developing and implementing of MOUs, improving the terms and conditions of the implementing the MOUs.

  Conclusion: Collaboration with other sectors has now become one of the main issues in health systems. For better achievement, strengthening the stewardship of intersectoral collaboration to effective coordination for drafting MOU, and facilitates and monitors the effective implementation of MOUs by identifying key people in each organization and empowering them is necessary.

Background: The main function of the strategy map is to determine the relationship between cause and effect among the strategic objectives, dimensions, and components of an organization, a large project or plan in which programs can be implemented effectively.  The current study aimed to map strategy and introduce the health system reform plan using an Iranian social responsibility-based approach.

  Methods: The current study was a qualitative and applied one using the Balanced Scorecard (BSC) principles and the Comprehensive Evaluation Model for Health System Reform Plan in Iran (CEHSRP-IR) model in 2019. the views of 17 experts were selected in management and health issues based on purposive non-random sampling, using Delphi technique paired comparisons, common techniques in strategy mapping, and SPSS and EXPERT CHOICE software, the strategy map of the health system reform plan was designed in Iran.

  Results: After elaborating on the fundamental aspects of this research, setting the strategic goals, dimensions, and components, as well as determining the relative weight of the components and dimensions and then prioritizing them, explained their optimal relationships to achieve strategic goals. Finally, using VISIO software, a strategy for the health system reform plan was designed and presented concerning social responsibilities. The present study resulted in designing a strategy map of the health system reform plan in Iran based on 5 dimensions of financial, social responsibility, learning and growth, clients, internal processes, 17 components, and 25 connections.

  Conclusion: The current strategy map can be sufficiently comprehensive to effectively implement nationally at various organizational and implementing units’ levels of the health system reform plan in Iran.

Background: This study aimed at designing and testing a model of indirect relationship between leadership styles, self-efficacy, structural empowerment and job performance with the mediation of psychological empowerment and self-regulation among teachers in Khoramabad city.

  Methods: The study was a correlation research via structural equations modeling. Population of the study were selected from high school teachers in Khoramabad city. We applied these questionnaires: Misha-Spreitzer psychological empowerment; Kappa Aydin et al self-regulatory; Patterson job performance; Blanchard-Hersey leadership styles; Kordnaij, Bakhshizadeh and Fathollahi structural empowerment; Woolfok and Shanen-Moran self-efficacy.

  Results: Participants in this study were 202 (52.5%) females and 183 (47.5%) males. In regard to education, 6 (1.6%) participants had diploma degree; 36 (9.4%) participants had above diploma degree; 251 (65.2%) participants had bachelor degree; 91 (23.6%) participants had master´s degree and 1 (0.3%) participant had a doctorate degree. The results of data analysis including 385 questionnaires completed by participants with Smart PLS (Partial Least Squares) software showed that model fits with data. Justifying and participatory leadership styles as well as structural empowerment had causal and indirect effects on job performance with mediation of psychological empowerment. Psychological empowerment and self-regulatory mediate the relationships between justifying leadership style and job performance; structural empowerment and job performance as well as self-efficacy with job performance. 

  Conclusion: Improving self-efficacy of teachers and structural empowerment helps to have self-regulating teachers with higher psychological empowerment. Self-regulation and self-efficacy and change in leadership style lead to structural empowerment in schools.

  Background: Healthy lifestyle factors are associated with a lower risk of stroke. The current study aimed to describe lifestyle-related risk factors in ischemic stroke.

  Methods: In this cross-sectional study patients with ischemic stroke in two age groups assessed for lifestyle. Demographic characteristics (age, sex, BMI, marital status, educational level, job type as low or full stress, living area), lifestyle habits, and past medical history in two age groups collected in the structured form by researchers. Chi-square (Fisher's exact) test for assessment of the statistical difference between categorical variables applied. Also, a multivariate logistic regression model was used to predict possible life-threatening lifestyles which can lead to stroke under the age of 50 (odds ratio, 95% confidence interval). All statistical tests were two-tailed and were performed with the use of PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. P values <0.05 were regarded as significant.

  Results: Totally, 11.2% of ischemic stroke cases were 50≥ years old. In the  multivariable logistic regression model higher BMI (P=0.02, OR =1.5, 95%CI=1.2 – 4.3), smoking (P<0.001, OR=1.8, 95%CI=1.08 – 2.56), alcohol drinking (P<0.001, OR=1.6, 95%CI=1.01 – 3.87), hookahs consumption (P<0.001, OR=1.2, 95%CI= 1.1 – 3.5) were predicting factors for ischemic stroke incidence in age ≤50 and only appropriate diet (low fat, sugar, salt, high fruits and  vegetables) (P=0.01, OR= 0.7, 95% CI= 0.04-0.87) was  preventive factors against stroke in age ≤50 years in compare with over 50.

  Conclusion: Based on this survey many lifestyle factors effects the incidence of ischemic stroke in any age group. Therefore, periodic monitoring and effective in educating healthy people should be planned.

Background: In the United States, medical care accounts for roughly 10% of health outcomes. All other contributions to health outcomes are attributed to genetics, environment, social circumstances, and behaviors. These categories are collectively known as social determinants of health (SDOH), which can cause health inequities and disparities. It is becoming increasingly important to address the underlying factors of health outcomes as reimbursement for quality of care becomes the norm in the United States.

  Methods: A literature review using Google Scholar was conducted to identify strategies that health care organizations can implement to address social determinants of health within their communities.   

  Results: At the organizational level, a robust population health management program and screening for social determinants are important to identify patients who may need assistance with social determinants of health. Technology is a critical tool for success with these endeavors; however, organizations must be cognizant of physician burnout. At the community level, community partnerships are necessary to extend care outside of the hospital’s walls. Additionally, selecting medical conditions associated with key social determinants is a practical approach to measuring return on investment. 

  Conclusion: Effectively integrating new programs, technology, and community partnerships that target the vulnerable populations into a healthcare organization can prove to be beneficial in improving health outcomes and lowering healthcare costs.

Universal Health Coverage is defined as preventive, curative and rehabilitation services which are available to all people in the community and can be accessed if needed.
Improving health care coverage is directly related to the access and integration of our staff to provide integrated care for the general public. Government investment in Primary Health Care will be the cornerstone of UHC.

the implementation of this approach will be challenging, and many developing countries have so far failed to achieve universal coverage due to a lack of adequate management capacity in the insurance sector, or differences in the method of calculating premiums in various organizations which have led to different effects.