Original Articles

Socioeconomic status and catastrophic health expenditure evaluation in IR Iran: A comparative study in 2004 and 2011

Majid Davari, Maryam Kheyri, Seyyed Mohammad Kazem Nourbakhsh, Reza Khadivi

Social Determinants of Health, Vol. 1 No. 2 (2015), 23 December 2015 , Page 48-59

Background: Health equity is a main principle of all healthcare systems in the world. Family Physician (FP) program, as a health sector reform (HSR) in Iran, was executed to reduce households’ health care cost and to achieve health equity in 2004. Meanwhile, catastrophic health expenditure is known as an accepted indicator in HSR evaluation. In this context, after determining and comparing socioeconomic status (SES) among different periods, we made an attempt to evaluate households’ health financial protection in different quintiles after implementation of FP program.

  Methods: The current cross-sectional study was based on the data obtained from Household Income and Expenditure Survey in 2004 and 2011. The health expenditures, catastrophic health expenditure (CHE), and SES were determined by this data during these years. Descriptive analyses and comparisons using Chi-squared test were carried out via SPSS, version 20.

  Results: A total of 1716 households were included in the survey during 2004 and 2011. The highest proportion of households was related to quintiles very poor and poor with respect to each year. Moreover, it was observed that SES in 2011 had the worse situation compared to that in 2004; this situation was worse in urban areas. In the present study, CHE is related to poorer quintiles, and in rural areas no household was faced with CHE in 2011.

  Conclusions: Implementation of FP program in rural areas with more primary care has prevented hospitalization. This was considerable for poorer quintiles and has led to financial protection for rural households.

Research Network of Tehran Defined Population: Methodology and Establishment

Ali-Asghar Kolahi, Ahmad-Reza Farsar, Shahnam Arshi, Mortaza Abdollahi, Alireza Abadi

Social Determinants of Health, Vol. 1 No. 2 (2015), 23 December 2015 , Page 60-70

Background: We need a defined population for determining prevalence and incidence of diseases, as well as conducting interventional, cohort and longitudinal studies, calculating correct and timely public health indicators, assessing actual health needs of community, performing educational programs and interventions to promote healthy lifestyle, and enhancing quality of primary health services.

The objective of this project was to determine a defined population which is representative of Tehran, the Capital of Iran. This article reports the methodology and establishment of the research network of Tehran defined population.

Methods: This project started by selecting two urban health centers from each of the five district health centers affiliated to Shahid Beheshti University of Medical Sciences in 2012. Inside each selected urban health center, one defined population research station was established. Two new centers have been added during 2013 and 2014. For the time being, the number of the covered population of the network has reached 40000 individuals. The most important criterion for the defined population has been to be representative of the population of Tehran. For this, we selected two urban health centers from 12 of 22 municipality districts and from each of the five different socioeconomic of Greater Tehran. Merely 80000 individuals in neighborhoods of each defined population research station were considered as control group of the project.

Results: Totally we selected 12 defined population research stations and their under-covered population developed a defined population which is representative of Tehran population.

Conclusion: a population lab is ready now in metropolitan of Tehran.

Impact of methamphetamine and opium use in sexual satisfaction and body image in married substance and non-substance user men

Anahita Khodabakhshi Koolaee, Ali Sarvestani, Ladan Mansour, Hassan Habibi, Masoumeh Rahmatizadeh

Social Determinants of Health, Vol. 1 No. 2 (2015), 23 December 2015 , Page 71-80

Background: sexual satisfaction is a vital component in marital satisfaction and life quality. The appraisal has influence sexual satisfaction. The previous study shows that people use methamphetamine and opium for enhancing sexual functioning.

Objectives: The current study was designed to examine the impact of methamphetamine and opium use in sexual satisfaction and body image.

Patients and Methods: The respondents were 100 non-substance user men with available  method and 53 methamphetamine users and 47 opium users with convenience sampling (age ranged below 50 years, mean=34.71). The respondents were completed Index of Sexual Satisfaction (Frazoni 1984) and Body Esteem Scale (Hudson 1981). Data was analyzed between three groups by utilizing the Pearson correlation and MANOVA.

Result: Body image is associated with sexual satisfaction in non-substance user (p<0.01) and opium user (p<0.01), but this relationship was not observed in the methamphetamine group (p<0.05). Also, significant difference was found between three groups in sexual satisfaction and body image (p<0.005). Besides, the results revealed that the average of body image and sexual satisfaction in non-substance abuser is higher than the substance user (p<0.05), and sexual satisfaction in methamphetamine group is higher than opium group (p<0.05).

Conclusion: These findings support the idea that body image is a critical factor in sexual satisfaction. Consequently, in addiction treatment must consider the psychological and physical impact of  methamphetamine and opium use in sexual function.


Keywords: sexual satisfaction, body image, methamphetamine use, opium use, men

Mental Health Status of Medical Students in Tehran: A Cross Sectional Study

Mohammad-Reza Sohrabi, Hamid Reza Karimi, Narges Malih, Ali Asghar Keramatinia

Social Determinants of Health, Vol. 1 No. 2 (2015), 23 December 2015 , Page 81-88

Background: Mental health of medical students who will be responsible for community health has great importance. This study was designed to determine the prevalence of probable mental disorders during the internship period of medical students. 

  Methods: This descriptive cross sectional study evaluated 404 medical students of Shahid Beheshti University of Medical Sciences, in Tehran, the capital of Iran. The data collecting instrument was a self-rated questionnaire including standard mental health questionnaire SCL-90-R, demographic and socio-economic data. The score 0.7 and above were designated as possible cases of mental disorders. Analysis performed by SPSS software, version 14 (SPSS Inc, Chicago, Il, USA). p-value<0.05 was considered significant.

  Results: 53.8% of participants were female, and 79.4% were single. From all participants, 14.1% had Global Severity Index (GSI) score more than 0.7. Mean and standard deviation of GSI score was 0.32 (0.27). The frequency of probable mental disorder in medical students was 16.3% in somatization; 24.5% in obsessive-compulsive; 15.6% in interpersonal sensitivity; 16.8% in depression; 18.8% in anxiety; 14.6% in hostility; 11.4% in phobic anxiety; 16.8% in paranoid ideation and 13.9% in psychoticism. Students who had no children, lived in dormitory, had good economic status and were satisfied with their private life and studying course had significantly lower GSI scores.

  Conclusion: Between 11 to 24% of the students had mental disorders in different dimensions and economic status, living place and number of children were related to the disorders.

Review Article

Indicators of children’s social health: development a conceptual framework to assess equity

Kambiz Abachizadeh, Soheila Omidnia, Alireza Tajlili, Habibolah Masoudifarid

Social Determinants of Health, Vol. 1 No. 2 (2015), 23 December 2015 , Page 89-95

Background: Social health is important to be assessed as a dimension of health. In this study we tried to determine areas and sub-areas of children social health indicators.

  Methods: In a structured way, we reviewed the main social health databases and documents since 1995, both Iranian and international were reviewed to develop conceptual framework and to extract indicators.

  Results: According to reviewed documents, indicators of social health were categorized into four groups. In first category indicators are related to system capacities such as facilities and institutions, financial, and human resources. Social system functions are classified as group two. The main subcategories of social health functions are policy development and enforcement, social marketing, community organizing, coalition building and collaboration, education, case management, screening, surveillance, and investigation. In group three, named as social factors, the main determined areas are life skills, early child development, family functioning, and social networks. Indicators related to social outcomes are categorized as group four. The main related positive social outcomes are social wellbeing and happiness and the main negative outcomes are physical health outcome (injuries, infectious diseases, etc.), mental health outcomes, development and learning outcomes, risky behaviors, academic outcomes, and legal outcomes.

  Conclusion: Our recommended model develops a conceptual framework for child social health indicators. This framework and extracted indicators can be used to compare different populations to assess inequity for evidence based policy making and to implement proper interventions.