Social Determinants of Health

No Abstract

  Background: Menopause is a natural event in which different degrees of psychosomatic changes occur. The social, demographic and behavioral factors in different nations have a significant effect on symptoms of menopause. The aim of this study was to determine the relationship between the personal, demographic, social and reproductive factors with symptoms of menopause and the frequency of the mental and physical symptoms of menopause among women in Tabriz, Northwest of Iran. 

  Methods: A cross-sectional study was conducted in the clinics and health centers of Tabriz, East Azerbaijan and Iran. A total of 300 women aged 40-60 years filled a questionnaire on the socio demographic variables, reproductive history and symptoms checklist.

  Results: Among the symptoms, muscle and joint pain (68.7%), and increased facial hair (20.5%) were the most and the least common ones respectively. According to participants, as age increases, the symptoms worsen (p=0.003).

The frequency of the symptoms of the employed women was less than those of retired ones and housewives (p=0.001). The physical and mental symptoms had negative relation with educational status (p<0.05). An increase in the number of the children, the history of the oral contraceptive use and dysmenorrhea had positive relation with the frequency of the symptoms.

  Conclusion: The quality of life of the women during menopause worsens with an increase in age and number of children, whereas it improves with higher educational levels and employment.

Background: Accidents are the second cause of death in Iran and one of the significant challenges in public health. They can affect people in all ages. In this study, we try to calculate years of life lost due to intentional and unintentional injuries, which is considered as one of the main indicators for prioritizing public health problems.

  Methods: This study is a practical cross sectional survey research HSR (health system research) that uses secondary analysis on the death data of Ghazvin province. The calculations also take into account the WHO standards in age group, sex and years of life lost (YLL) due to death.

  Results: This study showed that the unintentional accidents were the leading cause of death based on YLL from 2004 until 2008 in Ghazvin province. The number of deaths due to intentional and unintentional accidents was 3796 deaths as of which 2954 (77.8%) was male and 842 (22.2%) female. In general three quarter of the YLL due to early death relates to accidents for males and less than a quarter relates to accidents for females. Between 2004 until 2008, the maximum number of years of life lost (YLL) in both sexes is for the age group of 15 to 49.

  Conclusion: Considering the high level of years of life lost (YLL) due to accident in this province, especially in men, more appropriate interventions for the more risk prone age groups and male in general need to be taken into account.

Background: Breast cancer (BC) is a common malignancy among women. BC is a stressor in life that affects coping strategies and quality of life. This study performed to improve the quality of life in women with maladaptive coping style.

  Methods: A randomized clinical trial, held in 2011. Patients with maladaptive coping strategy were included in the study. 62 patients were randomized into two groups. Before and after 8 weeks of coping therapy, the quality of life was measured. General linear model was used for analysis.

  Results: The mean age in the intervention and control group was 45.10±7.34, 46.52±6.20 respectively (P-value>0.5). Functional health significantly improved after the intervention
(p-value<0.005), but in the control it decreased (p-value=0.029). Symptom health between the two groups demonstrated no difference before and after intervention. General health improved in the intervention group (p-value=0.017). However, in the control group it was not significant
(p-value=0.128). Problem-focused coping strategies in the intervention group improved markedly (p-value= 0.003) whereas, the control group did not reveal significant differences (p-value=0.196).

  Conclusion: The results showed that the coping skill training program can improve the overall quality of life of breast cancer in women, and indicated that the care of breast cancer should address psychological issues and the finding points to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial well-being.

Background: Today, the health sector in many countries is facing with severe resource constraints; hence it is absolutely necessary that cost-benefit and cost-effectiveness assessment have a major role in design of health services. The purpose of this study was to evaluate the cost-benefit and effectiveness of cervical cancer screening service (Pap smear test) done by the health centers in Damavand County in 2013.

  Methods: This is a descriptive study with cross-sectional method. All data was extracted from existing documents in Damavand health network.

Cost of service screening for doing Pap smear test (manpower costs of performing the service, the cost of transferring samples, water, electricity, telephone and gas) was estimated in all health centers then results, were compared with the incomes of this service.

  Results: Screening program coverage was 22.3%, 6.9% and 6.05% in 2011, 2012 and 2013 respectively. All costs and incomes of units performing Pap smear screening test were calculated. Entire costs and incomes of this service during 2013 were respectively 303,009,000 and 11,640,000 RLS equal $12,227 and $496.73. Therefore, the cost-benefit ratio of this screening test was approximately 0.040.

  Conclusion: The costs of units performing cervical cancer screening test in Damavand Health Center were much more than this benefit and because of a none-positive Pap smear test in spite of high cost, performing this test in Damavand health centers was not cost effective.

Abstract

  Background: Evaluate the adherence to facility management and safety standards among governmental and non-governmental hospitals in Shiraz, Iran.

  Methods: In this cross sectional study, 22 hospitals of the 33 hospitals in Shiraz, Iran including 13 governmental and 9 non-governmental facilities were surveyed. A 74-item self-administered questionnaire was used. Collected data were entered to SPSS Version 15.0 software. The level for statistical significance was set at 0.05.

  Results: Adherence to facility management and safety standards was 65.17% in governmental and 72.79% in non-governmental hospitals. Compliance by governmental hospital in the areas of leadership and planning, safety and security, emergency management, medical equipment, utility system and staff education ranged from 60% to 86%. However, hazardous materials and fire safety adherence was below 50%. For non-governmental hospitals standard compliance for all areas ranged from 60% to 86%. Compliance rates between governmental and non-governmental hospitals in the areas of hazardous materials and staff education standards were statistically significantly different (p=0.02 and p=0.05 respectively).

  Conclusions: To achieve more effective functional health care services, additional studies must be undertaken to assess the nature and extent of problem areas that exist in planning, implementing and monitoring of facility management and safety programs.