Social Determinants of Health

Background: Psychiatric disorders are very common, but their economic costs are not calculated transparently, while they are associated with significant economic consequences. The aim of this study was to investigate the direct and indirect costs of psychiatric disorders in 2017.

Method: The present cross-sectional study was performed on all psychiatric patients admitted to hospitals in Ibn-e-Sina and Hejazi hospitals of Mashhad. According to the International book of ICD10, the medical records of psychiatric patients admitted with Code of Mental and Behavioral Disorders (F32-F33.9) were first identified and their costs of hospitalized was extracted and investigated from the Hospital Information system.

The Top-Down Approach was used to estimate the costs. Descriptive statistics were used to analyze the data.

Result: During the study period, 6896 patients were discharged, of which 1915 (28%) had mood disorders and among the mood patients, 300 (16%) had depression.

The highest treatment cost for psychiatric patients is paid by insurance (93%).

The average length of stay in the hospital was 23.6 days, and the average cost of each patient was $ 1020. The greatest cost of depression patients is related to hoteling (62%) and doctor's visit (24%).

Conclusion: Depression is a common and costly disease and should be prevented by designing effective interventions

Background: Coronary artery bypass graft surgery (CABG) is one of the two most commonly used interventions for Myocardial Reperfusion. Studies suggest that the existence and direction of the effect of the factors affecting health-seeking behavior depend on the context of each society. Thus, this study aimed to introduce and validate a tool for investigating the factors affecting the health-seeking behavior of patients requiring a cardiovascular intervention as a prerequisite for planning and policymaking.

  Methods: By reviewing the literature and questionnaires previously used in the field of health-seeking behavior and the patient's decision-making process, a set of related questions was collected based on Kroeger’s model variables. Ten content experts were requested to evaluate each item and then content validity ratio (CVR) and content validity index (CVI) were calculated and used for instrument modification. Participants were included through a convenience sampling procedure. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) was used to assess construct validity. Cronbach's alpha coefficient was used to measure instrument reliability.

  Results: Of the 142 participants, 79 (55.5%) were male. Through the validation process, a hierarchical model with four factors and 20 items with three error covariance (accounting for 63.06 present of outcome variable variation) was confirmed. Also, an examination of the four constructs obtained with Cronbach's alpha coefficient was more than 0.8 indicating acceptable reliability.

  Conclusion: Findings suggest that the designed scale of health-seeking behavior based on Kroeger’s model is a reliable and valid scale among the Iranian population.

Background: Street children, due to their living and working conditions, are exposed to various injuries, and part of these are caused or exacerbated by engaging in high-risk behaviors. This study aimed to explore the sexual behaviors and their risks in street children.

  Methods: This study was conducted in 2012-2013 in Tehran using a rapid assessment and response (RAR) method. Data were gathered from 289 street children (boys and girls), who were selected through time-location sampling (TLS) method, and 16 interviews with key informants and 13 group discussions with street children who were selected through purposive and snowball sampling methods.

  Results: Among the study’s participants, 8.7% (95%CI: 5.3-11.8) reported a history of sexual abuse and 21.1% (95%CI: 16.4-25.8) had experienced sexual relations, in which, 37.7% of cases used sexual protection.

  Conclusion: The present study confirms the vulnerability of street children, the negative effects of environmental factors, and behavioral determinants of health and well-being. Further, it emphasizes the need for effective health interventions, particularly education and social support.

Background: Epileptic patients (EP) should be free of seizure recurrence (SR). Universal Health Coverage (UHC) was implemented in 2005 in Iran, aiming to tackle obstacles in front of health services’ utilization. This study was done in order to assess the SR rate in EP after UHC implementation.

  Methods: This study was a prospective time series that was done in rural areas of Falavarjan district in Isfahan province in central Iran from March 2016 to March 2017. 245 patients who suffering from any type of epilepsy and whom epilepsy confirmed by a neurologist, registered. All epileptic patients monitored continuously every month through the study, and the signs or symptoms attributed to the suspected seizure were assessed and referred to a physician for additional assessment and consultation to improve treatment compliance. 

The patients’ data about their demographic characteristics, type of epilepsy, any SR attack, and their risk factors were gathered from their self-files based on the checklists.

  Results: Despite treatment schedules that were carried out for all EPs, during one year follow up, however, 37 (15.1%) patients displayed SR attacks. 19 (7.75%) patients who suffered RS were male with the mean age of 40 ± 13.5 years, without gender statistical difference (P=0.810). In patients who had RS, the main causes of lacking adherence to their treatment were forgetting to take medicines in 10 (55.6%), poverty in 3 (16.7%), and lacking motivation in 2 (11.1%) EPs.

  Conclusion: Following UHC implementation in the primary health delivery system, that neuropsychiatric health packages were integrated, the incidence rate of SR attack in EPs was low.

Background: During the last decades, the average gap between attitudinal and behavioral youths’ marriage age has increased due to the changes in Iranian society and family patterns. This paper is devoted to studying this increment.

  Methods: Classification and Regression Trees (CART) are applied for modeling the marriage age gap (MAG) of 12741 youths selected by a multi-stage cluster sampling method from 31 provinces in Iran.  

  Results: Classification accuracies of fitted CART for females’ and males’ MAG were equal to .62 and .60, respectively. The most influential variables on females' and males' MAG were educational level and the number of siblings, respectively. Females with "university education," "diploma and less education with 5 and more siblings", and “employed diploma and less education with 3 or 4 siblings" married later than their desired time. Males with "3 and more siblings", "employed with 2 and fewer siblings and 3 and more ideal number of children", "employed university educated with 2 and fewer siblings and 1 or 2 ideal number of children", and " employed with 2 and fewer siblings and 1 or 2 ideal number of children with a diploma and less education and negative opinion towards childbearing" also married later than their desired time. 

  Conclusion: If the inevitable experience of modernity doesn’t combine with the convenient policy and the economic and socio-cultural conditions of the community don’t change, the negative consequences of such developments would be more than its positive achievements on different social issues especially and more importantly youth’s marriage age.

Background: The purpose of this study was to determine how community-based diabetes prevention programs utilized the concept and contents of the Community Based Participatory Research approach.

  Methods: Keyword search in PubMed and Scopus electronic databases from January 1, 2000, to December 31, 2019, was conducted to search and extract peer-reviewed articles that included words “Community-Based Participatory Research (CBPR)” and “diabetes mellitus” in the title, abstract or in the main article. The initial search yielded 1122 articles. After the final screening, a total of 67 articles were extracted for review.

  Results: Findings suggested that an advisory board was used by most diabetes studies, especially for planning and reviewing the study protocol. However, they were not included in the data analysis and study result dissemination process. Furthermore, the majority of the studies that used CBPR were conducted in North America.

  Conclusion: Partnership approach to research on community-based diabetes programs that equitably involves community members and researchers can benefit communities. This approach should also be widely adopted globally.

Background: People's participation in health affairs has been given more importance, recently. Establishment of the first National Health Assembly (NHA) in Iran was to shape dialogue among stakeholders and advocacy for health among all non-health sectors; decentralizing health decision making process, involving community and societies in health policy and planning, identification, appreciation, and development of health policies and measures in all economic, social, and cultural institutions of the country. This report summarized the Iranian context, process, and procedures of the establishment of the first NHA in Iran.

  Presentation of case: To ensure participation of all people around the country, provincial health assemblies, district health assemblies, and neighborhood health assemblies were formed throughout the country. The main theme selected for the 1^st NHA was “Health for All, All for Health”.

  Conclusion: The final statement mentioned that health is a citizens’ right and all people and organizations are responsible for it; therefore, cultural activities and legal support are needed for the institutionalization of social accountability for health.