Global determinants of health: new concept for control of pandemics

Mohammad-Reza Sohrabi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e14

Control and prevention of pandemics like COVID-19, is based on many factors that are not under authority of health system. Like “Social Determinants of Health” for inequity, we need to define a new concept in which factors that influence on wide spread of communicable and even non-communicable diseases are categorized. In this manuscript the concept of “Global Determinants of Health” is introduced as the key factors in controlling large scale epidemics and pandemics in global level. International transport and transit, Migration, tourism, world trading, market exclusivity, abroad and overseas workers, income, per-capita growth domestic product, radicalism, racism, and extreme nationalism, war, politics, international health organizations power and, influence, climate change, source of energy and, internet influence rate, are introduced as the main global determinants of health. They are in international level and affect rate of disease spread in many countries. Paying attention to these factors and controlling them could be effective in prevention and control of COVID-19 and future epidemics and pandemics.

Original Articles

Stigma, discrimination, and attitude towards the Chinese community in the USA and Canada during the outbreak of COVID-19

Adekunle Sanyaolu, Chuku Okorie, Aleksandra Marinkovic, Abu Abbasi, Jasmine Mangat, Sadaf Younis, Henry Chan, Urooj Jaferi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e12

Background: The COVID-19 outbreak, declared a global pandemic by the WHO, raises some serious health, as well as discrimination concerns worldwide. This study outlines the knowledge, stigma, and discrimination of people towards the Chinese community in the USA and Canada at the onset of the pandemic.

  Methods: An online community-based, opt-in descriptive survey was conducted spring of 2020. The study collected data with anonymity about demographics, travel history, COVID-19 knowledge, awareness, as well as stigmatization and discrimination against the Chinese community. Data was compiled with excel using descriptive statistics and Chi-square for the analysis.

  Results: Among 172participants, the highest number of responses came from the 21 to 40-year-old age groups. There was some reported stigma against the Chinese community in the study, particularly during the early days of the outbreak; 6.4% participants indicated that only Chinese infected COVID-19 individuals need to be quarantined with 13.4% avoiding only the Chinese community; Furthermore, 30% blamed people from China for the COVID-19 outbreak; while 13% people said they would avoid Chinese people and/or their communities. Results from the study suggest that those who live in urban settings, who are married and hold university degrees have a better understanding of the infection, knowledge of how it spreads, and also are less likely to discriminate against the Chinese community or blame the Chinese from China for COVID-19.

  Conclusion: Lack of knowledge caused anxiety and fear among some people, which thus played the main role in the rising cases of Chinese community stigma and discrimination reported.

Objective: This study aimed to compare the effect of autologous plasma rich platelet (PRP) versus Low molecular weight Hyaluronic acid (HA) on pain, function and stiffness in knee osteoarthritis during six months follow-up.

Design: Through a non-placebo blocked randomized controlled trial with parallel design on 77 patients with knee osteoarthritis; 50 in intervention group, treated by PRP; 27 in control group, treated by HA.  They received three injections and assessed before, after two and six months. Pain, stiffness and function were assessed using WOMAC and VAS. Descriptive statistics, chi-square, and ANOVA were used when appropriate.

Results: Pain reduced in both groups compared to their respective baseline (P<0.007); the reduction rates were similar in both groups (P>0.1). WOMAC and VAS scores were different between before injection and both two and six months follow-ups in both groups (P<0.001); although increasing of VAS score between two and six months follow-ups was more considerable in PRP but not statistically significant (P=0.08). Considering Kellgren-lawrence classification of knee osteoarthritis, WOMAC scores were different in patients with grade 2 and 3 in both groups (P<0.01); but VAS scores were different with grade 3 only in PRP group (P=0.009).

Conclusions: There was no difference between PRP and HA in reducing symptoms of knee osteoarthritis compare to their baseline but sustainability of the effect may be more with HA.

Prioritizing social determinants of health in East Azerbaijan: a qualitative research

Delara Laghousil, Mohammad Abbaszadeh, Mahasti Alizadeh, Nayyereh Mohammad pour, Ali Boudaghi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e17

Background: In order to improve health-centered decision making and planning to reduce inequalities in health, it is important to identify, classify, and prioritize social determinants of health. This study aimed to identify and rank three major social determinants of health in East Azerbaijan.

Methods: This research was conducted using a qualitative approach in grounded theory. Through purposeful sampling, 40 key informants from East Azerbaijan, North West of Iran, were selected and in-depth interviews were performed. The collected data was analyzed with a three-step coding method including open, axial, and selective coding using Corbin and Strauss’s systemic approach. Also, Interpretive Structural Modeling and “Matrice d'Impacts Croisés Multiplication Appliquée à un Classement” (MICMAC) analysis were used to identify and rank social determinants of health in East Azerbaijan.

Results: Of the 40 participants, 27 (68%) were male and 13 (32%) were female. The mean age was 39.28± 12.46 years. 63% had a doctoral degree. According to the result of MICMAC analysis, social harm, social capital, and good governance were identified as three major social determinants of health in East Azerbaijan province.

Conclusion: Social determinants of health have a significant and crucial role in human welfare and by identifying and prioritizing social determinants of health at a local level and/or national level, the first step can be taken toward social welfare.

Background: Cardiovascular diseases are among the most common, chronic and debilitating diseases. This study aimed at evaluating the effectiveness of compassion focused therapy on distress tolerance, difficulty in emotion regulation and anxiety sensitivity in patients with cardiovascular disease.

Methods: It was a quasi-experimental study with pre-test, post-test and a control group. The statistical population included all cardiovascular patients in Mashhad city in 2019-2020. The sample consisted of 30 cardiovascular patients referred to Valiasr clinic that were selected by available sampling method and placed in experimental and control groups. The experimental group underwent compassion focused therapy for 8 sessions of 2 hours and, at the end, both groups received post-test. The measurement tools were distress tolerance scale, difficulties in emotion regulation scale and anxiety sensitivity scale. Data were analyzed using SPSS software and multivariate analysis of covariance.

Results: The results showed that there was a significant difference between the experimental and control groups in the variables of distress tolerance, difficulty in emotion regulation and anxiety sensitivity (P<0.05); In other words, compassion focused therapy has been effective on distress tolerance, difficulty in emotion regulation and anxiety sensitivity in patients with cardiovascular disease.

Conclusion: Based on the results, this therapeutic approach can be used to increase distress tolerance and reduce difficulty in emotion regulation and anxiety sensitivity in cardiovascular patients.

Background: There is mounting evidence that clinicians need to address the social determinants of heath (SDOH) in their practice. Physician Assistants (PAs) who complete a joint degree with a Master of Public Health (MPH) may be able to address the SDOH in their practice better than those who do not have the degree. The primary aim of this study was to determine whether or not having a Master in Public Health (MPH) improves PAs’ ability to address the SDOH in their clinical practice.

Methods: A cross-sectional study was conducted with 25 practicing PAs who were jointly trained with the MPH degree and 32 practicing PAs who were not jointly trained. An online survey was administered to a gather SDOH knowledge, attitude and behavior data using an adapted 13-item SDOH scale.

Results: This study found that jointly trained PA/MPH clinicians reported significantly more perceived knowledge about SDOH (37.6 vs 31.1; P = .028), were more likely to identify SDOHs as important to their patients’ health (38.6 vs 32.9; P = .035), were more likely to intend to address SDOH with their patients’ (29.7 vs 23.5; P = .031) and reported feeling more comfortable talking about SDOH with their patients (3.75 vs 3.2; P = .05) despite no significant differences in reported barriers to addressing SDOH.

Conclusion: These findings suggest that joint clinical training with the MPH can positively impact PAs ability to address the SDOH in their clinical work and lays the groundwork for future research.

Health and psychological determinants of uncontested divorce in the city of Kermanshah

Amirali Babaei , Mostafa Amini-Rarani , Mahmoud Keyvanara

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e21

Background: Because of the increasing trend of uncontested divorce in the courts, as two out of every three divorces are related to uncontested divorce, scrutinizing the health and psychological causes of the rate of uncontested divorce is of great importance. The aim of this study was to examine the psychological and health factors affecting uncontested divorce

Methods: The present study was a cross-sectional data secondary analysis in which the existing data were analyzed. After obtaining official permission from the family courts in the city of Kermanshah, the data related to the issue of uncontested divorce during 2017 and 2019 were received and analyzed. The sampling method in this study was a census in which all legal cases of applicants for uncontested divorce in city of Kermanshah in the years of 2017-2018 have been reviewed.

Results: 2842 cases referred to welfare organization for consultation, of which, 2331 cases led to uncontested divorce and 511 cases not led to uncontested divorce (compromise). Among the psychological factors, the variables of suspicion, pessimism and depression; and among health variables, the variable of sexual satisfaction had a statistically significant relationship with uncontested divorce and anxiety, aggression and infertility did not have a statistically significant relationship.

Conclusion: Considering the role of suspicion and pessimism, depression and sexual dissatisfaction in uncontested divorce, it was recommended that specific preventive strategies should be considered by the authorities. These strategies can provide both education and counseling in pre-marital and post-marital periods, as well as during the uncontested divorce process.

Background: It is widely understood that most food-borne illness is associated with the inner home environment, and that therefore, the role of women in providing, storage and preparation of healthy food is very important. Given the lack of research on home food safety in Iran, this study focused on the knowledge and behavior towards food safety and its relationship with literacy among rural women.

Methods: Data of this cross-sectional survey were collected through questionnaires. The validity of the questionnaire was evaluated by referring to university experts. The questionnaire reliability was evaluated by Cronbach's test (a=0.782). The study population consisted of rural women in the areas of Gonbad-e Kavous County in Golestan province, north of Iran. Using random cluster sampling, 385 women from 77 villages were studied. Descriptive statistics and t-test were used for analysis.

Results: Knowledge and behavior of the studied rural women towards food safety could be assessed as good and fair respectively. There was no difference between literate and illiterate women in regard to food safety knowledge (t=1.72; P>0.05), but literate compared with illiterate rural women have in general better food safety behavior (t=2.16; P<0.05).

Conclusion: The findings showed that literacy education can activate mechanisms that lead to food safety behavioral changes. However, there was no difference between literate and illiterate women in regard to food safety knowledge. It suggests that illiterate rural women, despite their inability to read and write, can find appropriate methods to learn about food safety issues.

The Intermediary Role of Marital Satisfaction in the Relationship between Spiritual Experiences and Happiness of the Married Couples

Masoud Avarandeh, Zahra Eftekhar Saadi, Saeed Bakhtiarpour, Alireza Heidari, Parviz Asgari

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e23

Background: Happiness and vitality are enumerated as the primary and necessary natural needs of human beings and they can be envisioned as the most important factors of family-society health. The present study aimed to investigate the intermediary role of marital satisfaction, social support, and resilience in the relationship between spiritual experiences and happiness of the married students of Kermanshah. 

Methods: The present study was a descriptive research of the correlation type and it was specifically based on the structural equations model. The statistical population included married students of Kermanshah in 2018. A total of 356 married students was selected as the sample using the Morgan table. The research instrument included the Spiritual Experience Scale, ENRICH Marital Satisfaction Scale, Multidimensional Scale of Perceived Social Support, the Connor-Davidson Resilience Scale, and the Oxford Happiness Questionnaire. The data were analyzed using path analysis and SPSS 18 and AMOS 21 software packages. 

Results: The results showed that there was a direct and positive relationship between spiritual experiences with social support, resilience, marital satisfaction, and happiness (P= 0.0001). Based on the results, there was a positive and significant relationship between social support and happiness (P= 0.008). There was also a positive and significant relationship between resilience and marital satisfaction with happiness in married students (P= 0.001).

Conclusion: High spiritual experiences cause elevation of marital satisfaction via bringing about a shift in students’ attitudes and creating a positive value system and the high marital satisfaction subsequently makes the university students optimistic towards life.

Validation and Psychometric Properties of the Anger Management Skills Test

Yasin Farshchi Tabrizi, sadegh borazjani, Changiz Rahimi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e24

Background: More awareness of anger in different social situations can help us to manage it efficiently. Unfortunately, the questionnaire measuring these differences hasn't been validated in Iran. The primary purpose of this study was to investigate the psychometric properties of the Persian version of the Springer anger control skills test.

Method: The statistical population of this study was 200 college students consisted of 180 undergraduate, 15 M.Sc, and 5 Ph.D. students at Shiraz University. A random sampling method was used in this research. Springer anger control skills test was completed to assess the validity and reliability, Cronbach's alpha and internal validity, and exploratory factor analysis was used. 

Results: Results indicated the reliability of 0.62 and a significant value (0.001).  KMO value was 0.45. Also, a significant difference was found between males and females in anger‏ management and allocated to sociality and non-family relationships (0.001). Simultaneously, there was no significant difference between females and males in other variables and subscales of anger control.

Conclusion: Findings illustrate that this scale is reliable and valid and can be used in a clinical context. The difference between male and female in controlling anger in social situations can be related to Cultural influences and having more education; also, this sample only represents the population who had a higher level of education in comparison to others. Besides, they have received more educational training and necessary skills to cope with impulses and social encounters more appropriately.

A Methodology for Investigating and Addressing Sexual and Reproductive Health Inequities in the Sustainable Development Agenda

Sherine Shawky, Hoda Rashad, Zeinab Khadr, Shible Sahbani, Mohamed Afifi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e25

Background: Countries are committed to the international agenda and essential to achieving sexual and reproductive health goal is their capability to integrate equity lens in structural social determinants framing of inequalities. The aim is to propose comprehensive practical methodology which can alert countries to the injustice of sexual and reproductive health inequalities and provide tool to guide evidence-based policies and actions.

Method: The methodology was founded on literature review. This was followed by consultation meetings and workshops to drive scientific output. Finally, the methodology was applied on data in five Arab countries to illustrate its relevance.

Results: There are five contributions made. First, integrating equity lens to conceptual framing of sexual and reproductive health inequalities. Second, operationalizing the framework by articulating comprehensive list of indicators, adding distribution of gender norms, and choosing two inequality measures (index of dissimilarity and concentration index redistribution need) to allow for assessment of magnitude and comparisons. Third, illustrating the responsiveness of the health system and its relative contribution as social determinant of health. Fourth, demonstrating unfairness of root social structures and of social configurations of sexual and reproductive health. Finally, using the decomposition analysis and six questions to identify entry points for actions and responsibilities.

Conclusion: the proposed methodology provides countries clear way to assess severity and fairness of health-related conditions and not specifically sexual and reproductive inequalities. It offers an ethical urgency for addressing health inequities and guidance to main stream fairness in the full package of national policies.

Studying the Impact of Auditors' Anxiety on Auditor's Report Content

Mansoreh Zarrin Gharicheh, Rasoul Baradaran Hasanzadeh

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e26

Backgound: Auditors face a wide range of expectations due to conflict of interest between managers and investors that causes stress in the audit work and may have a significant impact on the quality of the audit.

Methods: This cross-sectional study was performed on 585 signatories of the audit reports of 139 companies listed on the Tehran Stock Exchange in 2016 and 2017. The statistical population of the study was the signatories of the audit report of the accepted companies in Tehran Stock Exchange. In present study, the information about anxiety of audit managers was collected using Beck Anxiety Questionnaire (1988) and multiple regression and logistic models were used to test the hypotheses.

Results: In this study, 585 auditors were examined. The results shown auditors' anxiety leads to presenting an acceptable report and a smaller number of condition clauses, but it does not affect the type of clause and the number of opinion clauses. The results show that auditors who are not anxious or are slightly anxious 371(63.4%) cases do not find themselves under the pressure of negligence of the client, but auditors with moderate anxiety 228 (39%) cases are more probably tend to present acceptable reports and therefore fewer condition clauses due to fear of losing their job.

Conclusion: As this study showed auditor's anxiety has no effect on the type of condition clause and also the number of clauses after the opinion; while auditors' anxiety affects the type of auditors' opinion and the number of condition clauses.

Explaining the role of job stress and ego empowerment in improving audit quality

Nasim Nasirpour, Mohammad Mehdi Abbasian

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e27

Introduction: Ego functions include communication with reality, regulation and control of instinctual forces, thematic relations, thought processing, defensive functions, combined functions and judgment.  The purpose of this study was to investigate the relationship between audit quality with job stress and ego empowerment.

Method: This was a cross sectional study conducted on the auditors of the auditing organization and independent auditing companies, which included at least 3 auditors in 2019. finally, 815 people create the total statistical population of this research. Audit quality questionnaire, Job Stress Questionnaire, and Ego Strength Psychological Questionnaire were used to collect data.

Results: Total number of 399 auditors with mean age of 31.7± 5.6 years (159 female and 240 male subjects) were included in our study. Results showed that job stress and ego empowerment can predict audit quality.  ego empowerment can predict audit quality. the effect of "job stress" on "audit quality" was confirmed as the null hypothesis, by a p-value of 0.465 (t0.95 = 1.96); so, significance of the effect of "job stress" on "audit quality" can be accepted at the level of type l error (0.05) in this model. job stress can predict the quality of auditing. Effect of "ego empowerment" on "audit quality" was confirmed by statistic P-value of 0.174 (t0.95 = 1.96), rejecting H1 hypothesis; so, ego empowerment can predict the quality of auditing.

 Conclusion: The results showed that job stress and ego empowerment can predict audit quality.

Background: The World’s population is aging due to simultaneous declining of birth as well as death rate leading to the phenomenon of demographic burden. The dependent population compounded by their chronic morbidities have little resources left to maintain a healthy nutrition, culminating in another morbidity i.e., geriatric malnutrition, which is grossly un-diagnosed and un-reported. A commitment to the Sustainable Development Goals means a commitment to Healthy Ageing, hence WHO had declared the next decade (2020-2030) as the “Decade on Healthy Ageing”.  Thereby, the present study aims to find the prevalence and correlates of elderly malnutrition in the index population.

Methodology: A cross-sectional study was conducted among 180 geriatric individuals of Bankura district of West Bengal using 30 cluster sampling design. Data on nutritional status were collected using MNA-SF questionnaire and correlates were assessed by a pre-designed pre-tested schedule Multivariable logistic regression was done to ascertain the factors influencing elderly malnutrition.

Results: Prevalence of geriatric malnutrition was 32.2% and risk of malnutrition was 48.89%. Presence of chronic diseases, poor socio-economic status, polypharmacy, food insecurity, catastrophic health expenditure and absence of social insurance were found to be significantly associated with geriatric malnutrition

Conclusion: Geriatric malnutrition was found to be considerably high in the study population. The complex interplay of multiple factors was found to culminate it, upon which socio-economic and health care affordability issues were prominent. A multi-disciplinary approach focusing on social security, improved health care delivery with Patient Oriented Evidence that Matters (POEM) approach may help in mitigating the issue.

Exiting Homelessness, The Perspectives of Those Experiencing Housing Instability

Edith Ahajumobi, Peter B. Anderson, Joseph C. Osuji

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e32

Background: For nearly thirty years homelessness has increased steadily in major cities around the globe, including Alberta Canada. Strategies adopted by the Canadian and Alberta governments to manage homelessness has yielded limited success. Signaling that Individuals experiencing homelessness are yet to be included adequately in search of solutions. Comprehension of homelessness phenomenon remains a challenge, as well as ending homelessness. The purpose of this phenomenological investigation study was to understand homelessness phenomenon from the experience of people who do not have homes and are experiencing housing instability.

Methods: A total of 15 respondents were recruited.  We performed in-depth, open-ended interviews for data collection. Following hermeneutic and phenomenological principles, interview data was retrieved, transcribed, summarized, described, and explained.

Results: The prominent themes indicated a need to make housing, and utilities affordable, and rent and mortgage qualification criteria easy; a need for revising of credit bureau and criminal record policies; people at the shelters entitled to welfare or other benefits requires grace period of at least three months before withholding payment of their entitlements; vital skills training is necessary to secure a job, for financial management, for positive behaviour, and supervised spending. Shelter awareness is necessary, and making government support services efficient, and non-discriminatory. End all discriminations and provide 40hrs/week regular full-time jobs.

Conclusion: The homeless, public, public health, and homeless service providers would benefit from the findings. Findings could help to stir homelessness reduction strategies to keep people out of the street in Canada.

Background: This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) on psychological capital and psychological well-being of patients with thalassemia.

Methods: This study was a quasi-experimental trial with a pretest-posttest design along with a control group. The statistical population included all patients with thalassemia referred to the office of the Thalassemia Association located in Mohammad Kermanshahi Hospital in Kermanshah. Thirty patients were selected as the sample by targeted sampling method and then randomly assigned to experimental and control groups equally (each n=15). The instruments included Ryff psychological well-being questionnaire and Luthan’s Psychological Capital Questionnaire. After performing the pretest, the experimental group underwent an ACT intervention, while the control group received no treatment. Data were analyzed using SPSS software version 21 according to analysis of covariance (ANCOVA).

Results: There was a significant difference between the mean of psychological well-being and psychological capital variables in both experimental and control groups (P=0.014 and P=0.005 respectively). By eliminating the effect of pre-test psychological capital scores as a covariate variable, the main effect of the independent variable on post-test psychological capital scores was significant (F=53.601, P=0.001). By eliminating the effect of pre-test psychological capital scores as a covariate variable, the main effect of the independent variable on post-test psychological well-being scores was significant (F=181.34, P=0.001).

Conclusion: ACT was effective on the psychological capital and the psychological well-being of thalassemia patients. Moreover, ACT can be used to improve the psychological capital and psychological well-being of patients with thalassemia.

Comparing the neuropsychological functions in obese and normal people

Sara Ashkani, Vahid Saadatian, Ali Reza Rajaei

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e34

Background: Obesity is a chronic heterogeneous disorder causing mental health problems and disorders. This study was aimed at comparing the neuropsychological functions between the obese and normal people.

Methods: This study was a descriptive and causal-comparative study conducted on obese and normal people between January and June of 2020. Participants consisted of 100 people (50 obese and 50 normal people) referred to Arian and Saremi clinics in Mashhad. Purposive sampling method was used and the participants were divided into two groups. The instrument was Wisconsin card sorting test (WCST) and Go / No-Go Task. Data were analyzed using SPSS 21 software and multivariate analysis of covariance.

Results: The results of the WCST showed that there were no significant differences between the obese and normal people in the variables of neuropsychological functions (P>0.05). Likewise, based on the Go / No-Go homework test, no statistically significant difference was found between the two groups in the variables of neuropsychological functions (P>0.05).

Conclusion: The finding showed that there was no difference between neuropsychological functions of the obese and normal people. It can be argued that obesity cannot affect neuropsychological functions.

The impact of successful intelligence on the social growth of preschool children with emphasis on the mediating role of social adequacy

Nasireh Moghaddamfar, Reza Ghorban Jahromi, Bita Nasrollahi, Fariborz Bagheri

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e31

Background: Social growth, as an important element of the development process, has significant impacts on children’s mental health. One of the most important goals of childhood education is the social growth and social adequacy of children. The extent they have these skills affects their individual and social health as well as their academic success. The purpose of this study was to identify the impacts of successful intelligence on social growth of preschool children with emphasis on the mediating role of social adequacy.

Methods: The present study was a descriptive-correlational research. Its statistical population includes preschool children in Tehran in 2019. Totally, 370 children were selected by multi-stage cluster sampling method. Vineland Social Maturity Scale, Sternberg Successful Intelligence Questionnaire, and Bellini Social Adequacy Questionnaire were used for data collection. For data analysis, Structural Equation Modeling was used.

Results: Successful intelligence has a direct impact on social growth and social adequacy of preschool children (β=0.19; P<0.004), (β=0.42; P<0.001), and an indirect effect on social growth of children with a mediating role of social adequacy (β=0.18; P<0.001). In addition, social adequacy has a direct impact on their social growth (β=0.43; P<0.001).

Conclusion:  The fit indices of the model showed that it has a good fit. Successful intelligence and social adequacy variables are effective in social growth of preschool children. They can be applied in the form of basic skills in formal education and as parenting skills to prevent and resolve interpersonal problems.

Factors affecting medical tourism: A case study of Azeri tourists in Iran

Kiarash Shafizadeh, Navid Hezari, Mohammad-Reza Sohrabi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e36

Background: Health tourism is one of the effective factors in the economic prosperity of the countries, the beautiful nature and hot springs of Ardebil province makes it a good destination for health tourism. The aim of this study was to investigate demographic and socioeconomic characteristics of health tourists in Ardebil.

Methods: To investigate the viewpoint of health tourists coming to Ardebil province from Azerbaijan, a comprehensive Turkish language questionnaire was designed by the researcher and by visiting medical centers in Ardebil, pharmacies and restaurants, the questionnaires were completed.

Results: Out of 200 distributed questionnaires, 193 were completed. The average age of the participants was 26.2 years. They often had less than 1800 USD monthly income. 184 (95.4%) of participants were not covered by the general insurance of Azerbaijan. The cost of treatment and the total travel cost per person for participants was less than 120 USD. About the hospital services, one-third of respondents rated them as “well”. More than 95% of the tourist were from the near border provinces.

Conclusion: The lack of public insurance coverage in Azerbaijan and the higher value of the Azerbaijani Manat compared to Iranian rial attract health tourists to Ardebil, but the quality of services provided needs to be improved. Government planners need to focus more on health tourism issues, especially in Ardebil so as to improve the infrastructures and remove barriers, it is a step towards the prosperity of this lucrative industry.

Effectiveness of acceptance and commitment therapy on emotion regulation in epileptic patients

Hamideh Sadeghnezhad, Saeed Teimory, Mehdi Amiri

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e37

Background: Epilepsy can severely affect cognitive-emotional and behavioral function. Using an appropriate treatment method to deal with it in order to treat emotional disorders can be an effective action due to the importance of this disorder. This study attempted to investigate the effectiveness of Acceptance and commitment therapy (ACT) on the emotion regulation in patients with epilepsy.

Methods: It was a quasi-experimental study (pretest-posttest design with equal control group) and the sample consisted of 30 patients with epilepsy selected purposefully and assigned into experimental (n=15) and control (n=15) groups randomly. The instrument included the Garnefski et al. Cognitive Emotion Regulation Questionnaire (CERQ). Data were analyzed using SPSS software version 21 conducting MANCOVA and ANCOVA analysis of covariance.

Results: The results showed that the ACT decreased negative emotion regulation and also increased positive emotion regulation in patients with epilepsy in the experimental group compared to the control group. The results of one-way analysis of covariance with the pretest control showed that there was a significant difference between the experimental and control groups in patients with epilepsy in terms of positive emotion regulation (F = 100.55, p <0.001) and negative emotion regulation (F = 154.64, p <0.001).

Conclusion: It can be argued that ACT reduced negative emotion regulation and increased positive emotion regulation in patients with epilepsy.

The hospital performance indices after implementing the Universal Health Coverage in the Iran

Reza Khadivi, Mahshid Sadeghi Dehcheshme

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e38

Background: The health sector evolution plan (HSEP) was implemented in 2014 in Iran. The aim of present study was to evaluate the hospital performances indices after implementing the second phase of universal health coverage (UHC) comparing to before.

Methods: In a cross-sectional study in 2019, the data of 58 hospitals were gathered from database in Statistics’ office in clinical deputy of Isfahan University of Medical Sciences (MUI), from 3 years before HSEP implementing to 3 years after that, between 2011 and 2017. Sampling was performed as census method. The data including the inpatient bed count in different type of hospitals (public hospitals affiliated to MUI, not for profit hospitals affiliated to the Social Security Organization (SSO), hospitals affiliated to military organizations, private and charity hospitals), the Bed occupancy rate (BOR), number of inpatients annually and the average length of stay (ALOS) in hospital, were collected and analyzed.

Results: By comparing to before carrying out the HSEP, the available beds, particularly in private hospitals was increased significantly (83.22%) after implementing the HSEP. Moreover, the number of hospitalized patients was raised after HSEP, in a way that, the highest percentages have been seen in charity hospitals and private hospitals with the growth rates of 140% and 69.44% respectively. Also, the longest ALOS was seen in public hospitals as likely as 3.4 days.

Conclusion: Following the implementing the HSEP, although the available beds and hospitalization rate have been increased significantly, however, the BOR and the ALOS have not been raised markedly.

Review Article

A review on Quarantine during COVID-19 Outbreak: Lessons Learned from Previous Epidemics

Kimia Vakili, Elahe Ahsan, Mobina Fathi, Niloofar Deravi, Shirin Yaghoobpoor, Melika Mokhtari, Tara Fazel, Mercede Holaki, Sara Javanmardi, Reza Shekarriz-Foumani, Maryam Vaezjalali

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e13

Background: Since the emergence in December 2019, the novel coronavirus disease 2019 (COVID-19) has caused a global pandemic that has infected so many people all around the world. As there are no vaccination or antiviral treatment available yet, public health measures play a substantial role in the management of this pandemic. Governments of affected countries have imposed different quarantine policies and travel bans. As quarantine can have many controversial aspects, this review intends to clarify its role in disease control and other aspects of human everyday life with due attention to a couple of epidemics in the past (SARS, MERS, and flu) and ongoing COVID-19 outbreak.

  Methods: We conducted a thorough search in PubMed, Research Gate, Google Scholar, Excerpta Media Database (EMBASE), and Web of Science databases and collected all relevant articles to Quarantine in the past epidemics (SARS, MERS, and flu) as well as ongoing COVID-19 pandemic.  

  Results:  A total of 176 articles were extracted in our primary search process. Primarily, 53 articles have been excluded because of duplication. The other 44 articles have been excluded due to different reasons (Lack of useful information and eligibility of data). Finally, 79 articles were selected for more evaluation (published until April 2020).

  Conclusion: By having previous epidemics, including SARS, MERS, and flu, in mind, quarantine and isolation seem to be proper choices for this situation. But, as this epidemy is bigger than former ones, stricter public health measurements, such as serious social distancing and community-wide containment, are recommended.

The Recovery with Nature and Flowers, Implications for the Coronavirus Disease Pandemic

Seyed Mohammad hosseini molla, Mustafa Ahansaz Salmasi

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e29

Connection with flowers and ornamental plants has been considered beneficial for psychological well-being since times of evolution. Despite nutrition and mutual use, human beings are an integral and essential part of nature, and there has been a logical harmony between man and nature. Since evolution, flowers have been known to be beneficial to psychological well-being in connection with nature. Ecotherapy (nature therapy) is a type of psychotherapy technique that is based on explicit environmental or ecological interventions. Social gardening and horticultural therapy and the principles of nature therapy have been integrated into other methods of psychotherapy for better effectiveness. This article tries to discuss the results of using it during the infamous coronavirus pandemic crisis.

Community Case Report

Background: Bhutan has a low-level HIV epidemic, with sporadic cases across the whole population. Our society is witnessing momentous social and cultural changes coinciding with the arc of the HIV pandemic. Therefore, this paper systematically assesses socio cultural determinants of HIV in Bhutan for appropriate responses to end the AIDS epidemic by 2030.

Methods: We reviewed the literature relevant to HIV in Bhutan using appropriate search engines. We adapted Dahlgren and Whitehead’s model of social health determinants in the population as a conceptual framework.

Results: Young age played the salient role between rapid sociocultural changes and HIV in Bhutan. Most teens are sexually active, has relaxed sexual norms, low condom use, and has multiple sexual partners. Gender identity and sexual orientation are increasingly fluid among transgender and gay/bisexual men. Worksites with migrants and entertainment venues are nexuses for sexual networking resulting in transactional/sex work.

Conclusion: Our findings suggest a high potential for a shift from diffuse cases of HIV to more concentrated HIV epidemic. HIV responses need to be tailored specifically for key populations instead of the current generalized approach. We recommend community-based HIV Self Testing and social support to overcome the structural barriers to enhance case diagnosis. 

Policy Note

Community resilience is the key factor to overcome COVID-19 disease

Nasir Dehghan, Zeinab Ebrahimi Fard

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e11

Community resilience can be defined as having the ability to cope with hardships and displaying flexible responses to daily life pressures which can vaccinate us against all types of tensions and stresses of life.

A resilient individual can stand strong in the face of social difficulties by utilizing his own biological- psychological balance. Enhancing this resilience can lead to huge progress in one’s self care and psychological skills. On the other hand, the resilience of urban communities forms the main foundation of societies’ solidarity in the face of crises and unexpected incidences.

Letter to Editor

Test and contact tracing: two wings to get rid of COVID-19 pandemic, until we get the vaccine

Ehsan shojaeefar, Niloofar Motamed, Narges Malih

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e19

In tracing a positive person for COVID-19, we are more likely to come across one of these scenarios: a party, a gathering, a restaurant, a flight, and so on. By tracing people and identifying these critical transmission points, we can do active testing for COVID-19 RT-PCR, recommend the self-isolation or quarantine to all individuals at the gathering, or improve the ill-structured places they had contacted, to prevent these spread multipliers and their associated costs. According to the Washington D.C.

The potential efficacy of influenza vaccines in prevention from cardiovascular complications of COVID-19

Moein Zangiabadian, Seyed Aria Nejadghaderi, Mohammad Javad Nasiri

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e20

Cardiovascular complications of COVID-19 are not as common as pulmonary complications, while they could be life-threatening. Also, because there is no prevention strategy with appropriate safety and efficacy for these complications, researchers and clinicians are recommended to evaluate different strategies. Effects of influenza vaccines on reducing inflammatory responses and robust immune system, as well as decreasing probability of SARS-CoV-2/influenza co-infection make it a strategy for prevention from cardiovascular events in patients with COVID-19. We suggest further preclinical and clinical researches be conducted to determine the efficacy of influenza vaccines in the reduction of cardiovascular complications in patients with COVID-19 (10).

The role of health integrated system in health transformation plan in Iran

Fatemeh Setoodehzadeh, Mohammad Khammarnia, Mostafa Peyvand

Social Determinants of Health, Vol. 6 (2020), 14 July 2020 , Page e35

E-health encompasses a wide extent and has excellent possible to grow in the future. Growing numbers of specialist believe that e-health will fuel the next breakthroughs in health system improvements throughout the world . There is frequent evidence that largely indicates failures or unsustainable e-health implementations in different countries for different reasons. Iran is also a developing country that is presently applying this promising technology for its traditional healthcare delivery .

the Iranian Ministry of Health and Medical Education (MoHME) has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP) in 2014. Nine main packages of healthcare services and provisions were considered as the core of the plan, including: i) reducing out-of-pocket expenditure, ii) increasing healthcare coverage, especially in remote, rural areas and recruiting physicians, healthcare workers and personnel in underserved areas, iii) e-health serves and... . These services should be provided free of charge to all rural and urban residents .