فصلنامه کومش
سال بیستم شماره 2 (پیاپی 70، بهار 1397)

Non-compliance is a concern to all healthcare disciplines especially in patients with chronic illness that is caused by social factors. For determining the factors affect on patient's health, it is essentialto understand the meaning of compliance and its measurement which lead to improve compliance. However, there is not any instrument to assess compliance of all dimensions of treatment in patients with chronic disease in Iranian context. The purpose of this study was to develop and psychometric properties of compliance questionnaire.
This study was conducted by triangulation approach in two concept analysis and methodological research sequential phases. In first part, Hybrid Model concept analysis was used to explore the meaning of compliance and to generate questionnaire items, and in second part psychometric properties was used to evaluate the validity and reliability of a compliance instrument.First, in theoretical phase of Hybrid Model concept analysis, data was collected by using literature reviews to develop a working definition. Second in field work phase qualitative data obtained through semi-structure interviews withparticipatingof 6 patients diagnosed with chronic disease. Third, in analytical phase, integration and reanalysis of the data gained during two former phases of concept analysis was conductedusing directed qualitative content analysis. In second part, a primary questionnaire was created by using the results of research. In the third part, the psychometric properties including face validity, content validity, construct validity, internal consistency, and test-retest reliability was measured.
The process of concept analysis in theoretical phase resulted in extracting 11 categories,in field work phase seven categories and in third phaseeight themes emerged. 127 items was extracted.The psychometric property was carried out as a result the 127-item questionnaire was modified and the items decreased to 48. The result of exploratory factor analysis showed that this questionnaire contains 7 factors including making effort for treatment, intention to take the treatment, adaptability, integrating illness into life, stick to the treatment, commitment to treatment and indecisiveness for applying treatment and the items decreased to 40. The 7 factors explained nearly 48.514% of the variance of the questionnaire. The reliability was carried out by using test-retest reliability andCronbachsalpha 0.92.
These findings offer helpful insights into the meaning of compliance and provide an instrument to assess the adherence of patients with chronic disease. The Adherence Questionnaire appears to be an appropriate tool for providing reliable and valid data to determine compliance in adult patients with chronic disease in Iranian context.

Hypertension is one of the most important health problems which cause significant morbidity and mortality and it can be affected by social factors. Life style modification is an effective strategy to manage blood pressure. This study aimed to determine the effect of educational program of lifestyle modification on adherence to diet and hypertension in hypertensive patients.
This randomized clinical trial study was done on patients with hypertension referred to Heart clinic at Sayyad hospital of Gorgan in 2015. Patients recorded adherence to diet daily (including 5 subgroups; salt consumption, fatty foods, fruits, fresh vegetables, and low fat dairies), based on the obtained scores they were considered as poor, average and complete adherence. 98 eligible patients with average and low adherence was chosen via convenience sampling and allocated into control and intervention groups using stratified random allocation (n=49). For modifying life style, face to face education took place for intervention group twice a week, over a 2-week period. Each session lasted about 2 hours. Patients in the control group received routine care without any intervention. Educational content relevant to hypertension was including description of hypertension, modifying life style (daily exercise and physical activity, smoking cessation, weight control, improving sleep pattern, decreasing anxiety and stress management), use of prescribed drugs, attend to follow-up appointments, and following recommended diet. Then, adherence to diet was recorded daily for two weeks in both groups.
Result showed that education of life style modification was effective on diet adherence (P Educational program for improving diet adherence as a practical life style modification may result to decrease blood pressure of patients with hypertension.

In the aging period, the need for food is one of the physiological needs of humans, the lack of which threatens them. In the meantime achieving food security for elderly women is influenced by several factors, including economic factors. In this study, an analysis of economic factors affecting the food security of older women is discussed.
The present study is applied in a descriptive-analytical manner in terms of its nature and method. The statistical population of the study is elderly women in villages of Zanjan (Iran). A total of 247 elderly women were selected by systematic method and a questionnaire completed by questioning the elderly woman. If there was any ambiguity in answering questions, further explanations were provided. Food Measurement Scale (HFIAS) has been used to measure food security..
The results of the research show that only 10.9% of elderly women have food security and economic factors such as housing, housing quality, garden area, amount of land, land area, amount of savings, number of donations, number of livestock, number of livestock Big, Takfel, Bank facilities, city and distance from the food shopping center to the food security of rural elderly women.
Elderly women in the studied area have high food insecurity and the most important economic factor affecting the reduction of food insecurity in elderly women is ownership of rained, blue and gardens lands. In order to reduce the food insecurity of elderly women, policies that cover this stratum should be taken into account from food baskets appropriate to age and mental health

Evidence suggests that self-care diabetes is one of the most important strategies for controlling the disease. Since it is required to assess the relationship between knowledge and depression with self-care in patients with diabetes mellitus, the aim of this study was to determine the relationship between depression and knowledge about diabetes with the amount of self-care in patients with type 2 diabetes.
In this cross-sectional study, 145 patients with type 2 diabetes mellitus were studied in Semnan Kowars Hospital. Data collection was performed with questionnaires demographic information, Beck depression, Audit of Diabetes Knowledge (ADKnowl) and Summary of Diabetes Self-Care Activities (SDSCA).
20.7% of patients had mild depression, 42.1% had moderate depression and 13.8% had severe depression. Overall, 76.6% of patients had a degree of depression (score of 10 or higher). The severity of depression had a significant relationship with marital status (P=0.004), education level (P=0.003), place of living (P=0.021), residential status (P=0.045) and age (P=0.002). The mean ± SD of knowledge was 14.5±2.8. Knowledge have a significant relationship with the variables sex (P=0.027), marital status (P=0.027), education level (P=0.009), occupational status (P=0.043). Mean ± SD of self-care was 23.1±5.9. Self-care had no significant relationship with any of the demographic characteristics. There were not a significant correlation between depression and knowledge (r=0.077, P=0.3555), depression and self-care (r=0.050, P=0.551) and self-care and knowledge (r=0.065, P=0.434).
The findings of this study showed a high prevalence of depression, moderate knowledge and low self-care in patients with type 2 diabetes mellitus. Since knowledge and depression were not significantly correlated with self-care, the factors related to self-care in patients with type 2 diabetes mellitus should be studied more widely, so that the identification of its related factors can be used to control the disease and its complications.

Since understanding patient's expectations is necessary for improving service quality, this study aimed to assess and determine the gap between hospital services quality and patient's expectations in Amir-al-momenin Hospital of Semnan University of Medical Sciences based on the SERVQUAL model in 2016.
This cross-sectional study with simple random sampling method conducted on 321 persons in two wards; obstetrics and gynecology (151 persons) and pediatrics (170 persons) in Amir-al-momenin Hospital in Semnan (Iran), using “SERVQUAL” standard questionnaire in 2016.
Results showed “expectations” and “perceptions” scores were “low “ and “relatively low” respectively. The "loyalty" of patients was “relatively low” and the gap between patient's perceptions and expectations, and in other words, "patients’ satisfaction", was ” very low”.
Very little difference between the patient's perceptions and their expectations in all determinants of the quality of services delivery indicates “very low” satisfaction of patients, so quality improvement in all aspects of service delivery seems necessary.

Today, social health along with physical, mental and spiritual dimensions of health, has become very important. Women facing infertility, more than other people are influenced by socio-cultural conditions and beliefs of every society. The aim of this study was to determine the social factors affecting the sexual experiences of women facing infertility.
This qualitative content analysis approach study, with regard inclusion and exclusion criteria, was done on 15 infertile women and key informant. Data were analyzed by conventional content analysis method. Gaba and Lincoln criteria were used to confirm the accuracy of the data.
By analyzing the data, three categories were obtained: 1) the impact of relatives and family on experiences (family and relatives of women, family and relatives of men and factors affecting both families); 2) the impact of society on experiences (lack of sexual education and social factors); and 3) common beliefs (beliefs related from cultural, religious or ethnic origin, beliefs related from nutrition, and the impact of schema on sexual behavior).
In Iran, according the social, cultural and religious background, childbearing is very important. It recommended, conducting educational classes for infertile couple families and special sexual health counseling for infertile couples. This consultation will help couples improve sexual performance, correct misconceptions, and reduce marital conflicts and divorce

Cognitive disorders in the elderly are more associated with symptoms of depression. Existing data about cognitive disorders in the elderly is very rare. In this account, the purpose of this study was to determine the cognitive disorders and some related Social factors in the elderly people in Semnan (Iran).
In this cross-sectional study, 260 elderly people aged 60 to 80 years old with at least primary education were included in the cluster sampling method resident in Semnan (Iran), in 2015. The households were systematically selected, based on the distribution of health centers in the city, and also according to the population of each center, the elderly of that area were determined and then to one fifth of households in each center. Data collection tools were demographic information questionnaire and cognitive health scale (Mini Mental State Examination, MMSE). The process of completing the questionnaires was that the elderly responded to the questions independently and was provided adequate and supplementary explanations, if there was any ambiguity about the completion of the questionnaire.
56.5% were female and the rest were male. 18.1% had mild cognitive disorders (21-24 points), 35% had moderate cognitive disorders (10-20%), and 1.2% had severe cognitive disorders (score less than 9%). 34.5% of men and 69.4% of women had cognitive impairment. Cognitive health had a negative significant correlation with age (P=0.001, r= -0.203), with a significant correlation with literacy (r = 0.754, p = 0.001). There was a significant relationship between cognitive health and sex (P Findings showed that more than half of the elderly had cognitive disorders. Conclusively, screening of cognitive disorders especially in women with a low level of education and also the elderly whose spouse's died, can be detected early and prevent the progression of the disorders

Given the prevalence of Internet use worldwide and its existing risks to societies especially the youngsters, information literacy can affect the use of Internet. Hence, the objective of present study is to assess the relationship between information literacy and Internet addiction and then to investigate the relationship between Internet addiction and general health of students in Iran University of Medical Sciences.
It is an analytical cross-sectional study which was conducted during 2016 on students in Iran University of Medical Sciences (Tehran, Iran). The sample size for the surveyed community of 6,500 university students was 362 from the Cochran sample size formula. Then, using a simple random sampling method, from each of the colleges, the sample size was selected according to the student population. Three questionnaires of information literacy, Yang's Internet addiction, and general health scale (GHQ-28) were distributed among students. Finally, 365 questionnaires were collected and analyzed.
29.9% of students were about to be addicted to the Internet, 1.3% had symptoms of Internet addiction and 68.8% had no addiction. In terms of information literacy, most of the students were in moderate level (60.5% moderate, 3.3% low, and 36.2% high information literacy level). There was a significant inverse relationship between increasing of information literacy and the Internet addiction (r = -0.45 and p According to the findings of this study, it was perceived that the higher the information literacy, the lower the level of Internet addiction; besides, reduction of internet addiction increased the general health of students. Therefore, considering the importance of students as the leading group in societies, and favorable consequences of increased information literacy, universitie's authorities have to develop and run specific programs within the educational and research schedule in order to increase the student's information literacy. Accordingly, undesirable outcomes of Internet use would be diminished and general health of society would be improved.

Students are important community members and their social and psychological well-being is of high value for the community. Social and psychological capital as an important factor can help students to achieve academic progress. This research was carried out with the aim of investigating the relationship between social and psychological capital and academic achievement of students of Semnan University of Medical Sciences.
This was an applied study that was conducted on 400 students of Semnan University of Medical Sciences (2016-2017, Semnan, Iran). Data collection tools were Oniks and Bollen social capital and Luthanz psychological capital questionnaires.
The results of the research showed that there is a positive and significant relationship between student's psychological and social capital (r = 0.41, p = 0.001). The results also showed that there was no significant relationship between student's psychological and social capital with age, gender and marital status (p The results of the research indicate the importance of the role of psychological and social capital with students’ academic achievement. According to the results obtained, implementation of programs to increase students 'psychological capital can help to improve student's academic achievement. According to the results obtained, implementation of programs to increase students 'psychological capital can help to improve student's academic achievement.

The use of anabolic-androgenic steroids (AAS) by athletes is a serious widespread public health problem. Therefore, the present study aimed to determine the effectiveness of educational programs on prevention of AAS use among male bodybuilders in Hamadan based on Prototype Willingness Model (PWM) as a theoretical framework.
In this quasi-experimental study, 76 male bodybuilders were randomly divided into two experimental (n=37) and control groups (n=39) in Hamadan, west of Iran in 2017. For this purpose, 5 gyms were randomly selected from Hamadan's gyms. Then, gyms randomly allocated in the experimental (2 gyms) and control groups (3 gyms). Finally, participants of each group were selected through simple sampling method from each gym according to the inclusion criteria. Data was collected using a questionnaire, including the PWM constructs and demographic variables. The intervention comprised 5 sessions, applied on the experimental group during one month. Both groups were followed for two months after the intervention.
There was no statistically significant difference between the two groups in terms of demographic variables and PWM constructs before educational intervention (P>0.05). After the educational intervention, significant differences were observed in pre- and post-intervention score changes on subjective norms (P=0.040), prototypes (P=0.034), behavioral willingness (P The results showed that the application of educational program based on PWM would be considered as an efficient educational strategy for the prevention of possible increase AAS use among male bodybuilders.

Micronutrients deficiency including vitamins deficiency in children is one of the prevalent nutritional problems all over the world. There are different strategies to control this malnutrition. Supplementation with A or multivitamins is one of these strategies. The aim of this study was assessing mothers’ practice about usage of A supplement for infants in 6 to 24 month infants of Semnan city.
In this cross - sectional study 400 mothers who referred to Semnan health centers in 2013-2014 (Semnan, Iran) were included the study via convenience sampling. The practice was studied in three area. Once the performance of the mother in the field of feeding of the supplementation to infants was desirable that she fed the infant by supplement in the day prior to referring. Favorable condition in terms of onset time of the supplement, starting it since 15th of birth, and finally on the dosage of it, has been used as order of 1 cc per day.
85.4% of participant mothers in this study had optimal practice in terms of the administration of supplement. About onset time, practice of 91.6% of mothers and in related to supplement amount, practice of 79.7% of them was optimal. There was a significant relationship between mothers’ practice about supplement onset time and nationality (OR=8.24, 95% ,CI: 2.48-27.43,P= 0.001) and between supplement amount and fathers’ education (P= 0.001) .There was not significant relationship between mothers’ performance about feeding supplement to infant and mother's age, mother's education, father's education, mother's and father's job, infant's gender, birth rank, mother’s nationality, condition of referring to health center and the place of receiving child care. The most common reason of undesirable mothers’ practice about feeding A supplement was amnesia (79.2%).
Mother's practice, related to the regular feeding supplement to infants and the strict observance of its amount need more attention. In this regard, the effective and continuous education of mothers and increasing their awareness, particularly mothers belonging to low literacy husbands, are significant and workable along with other facilities such as free distribution of supplements and their quality improvement.

Household financial contribution (HFC) in health is one of the most important goals of health systems. The purpose of this study was to compare the exposure of households to catastrophic health expenditures and impoverishment before and after the health sector evolution (HSE) plan in Iran in a big governmental Hospital.
This study investigates the households with hospitalization history in public and tertiary referral hospital, CHE is calculated using representative data from Households receiving expensive interventions in the imam Reza hospital. Data related to treatment expenditures were obtained from Hospital Information System (HIS) and data related to households’ food and non-food expenditures were obtained using questionnaire in expenditure-income survey of Iran’s Statistics Center as well as phone calls to the households. Households who had dedicated ≥40% of their Capacity to Pay (CTP) to health expenditures experienced catastrophic health expenditures.
Exposure to catastrophic health expenditures in the households decreased from 81.1% before the implementation of HSE to 66.7% after the implementation of HSE (p Exposure of households receiving expensive interventions to catastrophic expenditures and impoverishment is decreased. The findings of this study can be generalized to similar hospitals. At the same time, more comprehensive studies with cost effectiveness analysis perspective can show the more aspects of HSE.

Many studies have indicated that the professional driving is as a stressful occupation in the world. Few studies explored the effect of work-related stress on burnout among locomotive drivers. This study aimed to examine the association between work-related stress and burnout among Iranian locomotive drivers.
This cross-sectional study was carried out on 67 locomotive engineers of the Islamic Republic of Iran Railroad Company in 2017.Occupational stress was assessed by the standard questionnaire from health and safety executive, and burnout was assessed by the Maslach survey questionnaire.
More than 43% of the participants experienced high and very high levels of work-related stress. Occupational burnout dimensions were predominantly deteriorated personal efficacy (52.5%), emotional exhaustion (40.2%) and depersonalization (38.8%). The high level of occupational stress was significantly associated with emotional exhaustion (p=0.037), depersonalization (p=0.041), and personal efficacy (p=0.009).
Considerably, our study highlighted high work-related stress among locomotive drivers. Additionally, occupational stress showed to be linked to various dimensions of burnout. It is crucial for occupational health and safety division to decrease occupational stress to improve physical and mental health of locomotive drivers.

Marital and job satisfaction are two important categories of human's life. In this way, marital satisfaction is the basis of stable family, so that in its warm environment, humans reach to grow and maturity and occupation also forms an important part of the social identity of individuals. Therefore, this research was conducted in order to investigate the relationship between marital and job satisfaction in employees of health center in Garmsar county (Iran) in year of 2017.
96 married employees at the Grammar health center, Semnan, Iran were investigated in this cross-sectional study. In order to collect the data, , questionnaires of Enrich satisfaction marital (47 questions) and job questionnaires of Bryfyld and Ruth (19 questions) were used.
The results showed that 72.2% of women and 81% of men had relative and moderate marital satisfaction. Marital satisfaction between men and women were no significant difference with together (P= 0.746). Mean ± standard deviation of job satisfaction score was 2.99± 0.22, This score was 3.01 ± 0.23 for women and was 2.96± 0.3 for men, but the difference was not significant(p= 0.197) .Correlation between job and marital satisfaction was significant and positive (p= 0.004, r= 0.293).
According to the positive and significant relation between marital and job satisfaction, and also given that this point: a part of the person's life is spent in the working environment, and another part of him/her life is spent alongside the spouse, if the person has an unpleasant feeling in any of the marital or job environments, it can reduce satisfaction in another environment. Therefore, in order to increase and improve a personnel's job and life satisfaction, educational programs can be conducted for marital life skills and also occupational stress management.

Sexual dysfunction is a common health problem. Rural women are largely deprived of sexual health services. Regarding this, the present study aimed to investigate the prevalence of sexual dysfunction among the rural women and the underlying factors associated with this problem.
This descriptive, cross-sectional study was conducted on 405 rural women referring to the healthcare centers of Neyshabur, Razavi Khorasan, Iran, during Jan 2017 to April 2017. The study population was selected through multistage random sampling. The data were collected using a demographic form and the Persian version of the Female Sexual Function Index (FSFI). The FSFI covers six domains, including libido, sexual arousal, vaginal moisture, orgasm, sexual satisfaction, and pain. In this index a total score of less than 28 indicates an undesirable sexual function.
According to the results, the mean sexual function of the rural women was 24.0 ± 5.0 (95% CI: 23.5-24.5). Considering the standard cut-off point, the prevalence rate of sexual dysfunction was 83.5 among the participants. Furthermore, the most and least frequent dysfunctions were sexual arousal and vaginal moisture, respectively. The results showed that the sexual dysfunction had a significant relationship with the males’ education level (P As the findings of the present study indicated, the rural women had a high level of sexual dysfunction. Therefore, planning for specific sex education programs should be taken into consideration. The presentation of these kinds of trainings in the rural schools not only bears economic and social benefits, but also facilitates the improvement of sexual performance.

Cardiovascular diseases are the most common cause of death in the world and in Iranian people. Social determinants play an important role in explaining the consequences of cardiovascular disease. The current study aimed to explore the structural relationships between social capital, social support, as two social determinants of health, and satisfaction with self-care program in patients referring to cardiac rehabilitation centers in Isfahan (Iran).
this cross-sectional study was conducted in Isfahan in 2016. A total of 155 cardiovascular patients were recruited, who were selected from two cardiac rehabilitation centers in Isfahan (Iran). The patients completed a pack of questionnaires including satisfaction with self-care program Checklist, Multidimensional Social support Scale and Social Capital Scale. Structural equation modeling was employed to analyze data.
Out of total patients, 112 (72.3%) were male and 43 (27.7) were female. There was significant and positive relationship between social support, as a mediating variable, and satisfaction with self-care program (r=.0.49, P-value the final model confirmed the direct and indirect effects of both structural and cognitive social capital on satisfaction with self-care program through social support. According to results, it can be concluded that supportive issues and social relations networks, as a social determinants affecting on health, can be important factors in determining patients’ satisfaction with self-care program in cardiac rehabilitation centers.

Start addiction with positive attitude to drug. The purpose of this study was to investigate attitudes towards narcotics and relationship between family components with attitudes towards addiction in high school students.
In this cross-sectional study, 340 male students of secondary school in Semnan (Iran) were selected by multistage sampling technique from five male schools randomly selected. Then, in each elected school, a class was selected randomly from each grade. The data collection tool was personal and family information related to the subject of research, 20 questions of insecurity questionnaire in the family center with a range of 0 to 20, and 40 questions of drug attitude questionnaire, which included three subscales, with a scoring range of 40 to 200.
Mean ± standard deviation of student's age was 16.4 ± 0.8 years. 27.6% had a very negative attitude, 39.7% had a negative attitude, 28.2% had moderate attitude, 3.8% had positive attitude and 0.6% had a very positive attitude toward narcotics. There was a significant positive correlation between the family's emotional atmosphere and the attitude toward drugs (p = 0.006, r = 0.151), effects (r = 0.99, p = 0.029), risks (p = 0.1111), R = 139) and consumption (r = 0.09, p = 0.11), respectively. Also, students with addicted fathers had a more positive attitude toward narcotic drugs (p = 0.004), effects (p = 0.019), risks (p = 0.021), and drug abuse (p = 0.001). There was a negative correlation between attitude toward narcotic effects and household income (p = 0.033, r = -0.117). Students who are prohibited from drugs by parents have a more negative attitude toward narcotics (p More than a quarter of these students have a modest attitude toward drugs abuse, these are at risk. These people are the children of families with different education and income. It is essential that family empowerment programs be developed so that parents learn how to communicate properly with their children and increase the emotional affinity of the family and prevent them from being addicted to their dangers. This can reduce the percentage of students at risk of positive attitudes and prevent harm to society.

Online social networks allow users, who are anywhere in the world, to communicate with other people with text, audio, and video. Studies have shown that older adults use of social networks and online communication can increase social support, improve quality of life and increase their health. The purpose of this study was to understand the older adult's experiences of online Social Interactions.
This study was performed following a qualitative approach and phenomenological methodology in Semnan (Iran) in 2016. The studied sample was taken by purposive sampling method. Required data was collected via deep and semi-structured interviews with 9 older adults who were active members of at least one online social network. The obtained data was analyzed using the seven-step Colaizzi's method.
From data analysis, the main theme of "developed social interactions" was extracted from five sub-themes: "interaction with family and friends", "revival of old relationships", "familiar with people with common interests", "impalpable control" and "liberation from loneliness".
The results explained the various dimensions of the use of the older adults from online social networks and showed that these networks have the potential to be used to enhance social interactions in aging. The results of this study can help planners by identifying the benefits of these networks, while taking necessary interventions to increase the use of the elderly from these networks, promote social interactions and, consequently, promote the health of the elderly.

Intimate partner violence (IPV) occurs in all countries but its prevalence varies greatly across the world and remains unacceptably high with numerous consequences ranging from psychological to maternal disorder, neonatal mortality and morbidity outcomes in pregnant women. The aim of this study was to identify social determinants associated intimate partner violence among pregnant women in Hamadan (Iran).
This cross-sectional study was performed on 1039 pregnant women living in urban and rural areas in Hamadan (Iran, 2015). The data included socio-demographic characteristics in social determinants. The tool was standard questionnaire of violence (IPAQ) for measuring physical, psychological and sexual experiences of violence in the past 12 month.
The results showed that 88% of pregnant women had experiences of violence in the last year. The most experiences of violence were mental violence (87.9%), emotional violence (18.9%) and sexual violence (6.4%). The logistic regression analysis shows that frequency of mother's marriage (OR= 0.18, p=0.003), number of children (OR= 0.52, p=0.041), mother's employment (OR= 0.44, p=0.039), Smoking (OR= 1.91, p=0.019), and mental illness in a spouse (OR= 2.63, p=0.023), unwanted pregnancy (OR= 1.62, p=0.047), and awareness of wife's pregnancy (OR= 12.94, p=0.012) are significantly associated with kind of violence.
The findings confirm that intimate partner violence against pregnant women is widespread and not inevitable. IPV as health problem must be addressed. In order to mothers and the community health promotion, the results of this study suggested the allocation of funding, future research and interventions based on social determinants of intimate partner violence.

The status of financial participation of individuals in health financing is one of the challenging issues in assessing the performance of health systems in the world. The concern about the financing of the health system and its consequences on Iranian households from about a decade ago is a turning point in attracting the attention of researchers and policymakers to this area. This study has been calculated financial contribution of people in Iran health system in 2015.
Using cost-income information of 38252 Iranian households collected by the Statistical Center of Iran in 2015, the distribution of health expenditures of households based on the income approach is calculated and factors influencing the concentration index are measured.
The results showed that the concentration index of health care expenditures in Iran was 0.3318. This is indicative of the progressive status of household participation in financing the health system. Also, dental expenditures with the index of 0.496 have the highest inequality in the distribution of health care expenditures. Payment for hospital services and dental care services had the highest share in increasing the coefficient index.
Having insurance coverage as one of the most important policy tools to achieve the desired model of household financial participation has a significant effect on the distribution of financial participation of households and the most important factor in reducing the coefficient of concentration index

The Social Determinants of Health (SDH) are mostly responsible for health inequities, the unfair and avoidable differences in health status seen within and between countries. It contributes about 50% of community health status; however, the significant role of medical science universities toward it cannot be ignored. Unfortunately, lack of accountability of them about SDH conditions caused their duties has been increasingly criticized. For this reason, faculty members need to review their attitudes and practices so that they can play a suitable role in social change more than ever. The present study aimed to design and introduce the model for utilizing Social Determinant of Health approach by faculty members of Universities of Medical Sciences.
Qualitative study is carried out in two stages: Educational Needs Assessment and producing Educational Content. A review of the literature, focused group discussion and the completion of a questionnaire were used to gather information on the educational needs of faculty members in utilizing SDH. The population studied was faculty members of Qazvin University of Medical Sciences of Iran and sampling was deliberate. Collected information is summarized in the form of a workshop package including a lesson plan, scriptwriter, educational notebook and guide's tutor. It has been conducted experimentally in Qazvin University of medical sciences with basic, clinical and public health science. Finally, the evaluation results were applied to the final package.
The three main duties of a faculty member are research, education and practice. The practical applications of SDH in these areas are: 1. doing a comprehensive look at the patient's problems, including all four dimensions of physical, mental, social and spiritual well-being. Moreover, social roots of the disease should not be neglected. 2. Supporting advanced research ideas in basic, clinical, and public health 3.Teaching comprehensive (systemic) approaches to students, educating students about the roots of the diseases, offering a suitable solution to prevent non-communicable diseases, advocating for serious attention of policy makers about roots of diseases, and participating in leading positive social change. This package consists of three parts: the content of SDH, Iranian Health indicators, and the necessary interventions for improvement and applying these bases by the faculty members.A total of 36 minutes of educational film and 10,000 words pamphlet have been prepared in the form of training workshops for 180 minutes. The result of this training package showed that faculty members had a history of practical implementation of these concepts but their motivation increased by 75% compared to the pre-workshop.
Considering the important role of faculty members to utilizing the SDH, this package should be integrated into faculty empowerment workshop. It is suggested that these workshops are supervised by a joint committee including Medical Education Center (EDC), Social Determinants of Health Research Center, and health policy unit. As a result, these packages will gradually be updated and native based on the creative ideas of participants.

Maintaining physical and mental health of mothers plays an important role in health of family and society. Fear of childbirth and increase of caesarean section, has negative effects on pregnant women. The aim of this study was to study effectiveness of midwifery counseling based on solution-focused approaches on fear of childbirth.
This clinical trial was conducted on 60 pregnant women at week 22-30, who had fear of childbirth and choice cesarean section, in 2016. The women were divided in two groups by randomization; intervention groups (Solution-focused counseling: 6-session) and control group (routine care). Before and after intervention, a questionnaire including demographic and midwifery information, performance and W-DEQ questionnaire was completed. Data were analyzed by t-test, Chi-squared test and mean and standard deviation in two groups. While the level of p The mean and standard deviation of fear of childbirth before intervention in two groups was not significantly (p=0.081). But after intervention, fear of childbirth in intervention group was significantly decreased than control group (Mean and Sd in control & intervention groups respectively 68.78±29.51 vs. 40.62±11.11) (p 0.001 Before the intervention, all the women in both group prefer the cesarean section or doubt about their childbirth type favorite(p=0.25). But after the counseling, preference of natural childbirth significantly increased in intervention group (74% in intervention group compared to 46.4% in control group, p = 0.013).
The solution-focused counseling is an easy and effective approach to reduce the fear of childbirth & increasing preference of natural delivery

Bipolar disorder is severe, chronic, pleomorphic and often recurrent, which can lead to severe abnormalities in lif's function. The purpose of this study was to determine some factors related to the time interval between relapse in bipolar disorder.
In a retrospective study, 606 patients with bipolar disorder at Avicenna hospital in Mashhad were collected. In this study, 329 patients with at least one relapse of bipolar disorder were included. Survival time was defined as elapsed time from discharge to readmission due to relapse of disease. These patients wereadmitted from the beginning of 2008 to the end of 2009 due to their illness and were include in the study and followed until the end of 2013. The log-skew-normal accelerated failure time model was fitted to identify the factors related to the time of relapse. Estimation of parameters was obtained based on the Bayesian approach using Markov chain Monte Carlo algorithm by Open BUGS.
The estimate of mean and median time between discharge and readmission were 25.6 and 15 months, respectively. Age, family history, drug use, and gender had a significant association with the time of relapse, such that, male, younger patients, drug users, and positive family history of disease experienced a recurrence of disease earlier. With the mentioned variables in the model, stress and education were not associated with the recurrence of disease.
Given that the time interval from discharge to recurrence of type 1 bipolar disorder is low in men, young people, family history of positive and drug users, it is recommended to identify strategies to prevent relapse or delay in these groups.

Sexual motivation and sexuality, like all other fundamental human motives, form an inseparable part of its biological, psychological, and social nature and is associated with many factors. The present study was conducted to test the model for the relationship between the social determinants of health and sexual function in women.
This sectional descriptive-analytic study was performed on 400 women referred to the medical centers affiliated to Shahid Beheshti University of Medical Sciences (Iran, 2016). The participants were selected through multi-stage random sampling. For collecting the data, demographic and socio-economic status, Spielberger’s anxiety, perceived social support, domestic violence, unhealthy behaviors, beck depression and sexual function questionnaires were used.
The findings suggested a mean score of 16.6±68 for sexual function index in women. The mean score of depression was found to be 12.7 ± 10.3 and most of the subjects (44.8%) received moderate social support and 75%moderate anxiety. A total of 70.3% of the subjects had favorable economic conditions, while 50.5% suffered violence. According to the path analysis, depression (β = -0.34), anxiety (β = -0.24) and social support (β = 0.18) directly affect sexual function. Socioeconomic status and domestic violence were found to be indirectly associated with sexual function, and in the overall effect depression had the most effects on sexual function .The model proposed in the present study has a good fit (GFI =1 RMSEA =0.057, P value=0/015).
Sexual function was found to be associated with depression, anxiety, social support, domestic violence and socioeconomic status. Screening is recommended to be performed for the study variables.

Health System Evolution plan (HSEP) and relative values of hospital services are one of the most significant reforms in Iran's health system in the recent years. This study aimed to determine the effect HSEP on financial performance of para clinic units in a big hospital in Mashhad (Iran).
This cross-sectional descriptive study was conducted in para clinic units including of laboratory and radiology in Imam Reza hospital from April 2014 till March 2016 using activity based costing (ABC) method. Data relating revenue and cost were gathered using standard forms and were analyzed using descriptive statistics by Excel 2010 Software.
Total revenue of laboratory and radiology unit has decreased by 9% and 7%, respectively after HSEP. While these have increased by 94% and 111%, respectively, after tariff change. Total cost of laboratory ward has decreased by 21% after HSEP while has increased by 36% after tariff change. Total cost of radiology ward has increased by 9% and 53% respectively after HSEP and tariff change.
The implementation of a HSEP and relative values of hospital services has improved the income of para-clinical units. However, the impact of these changes in the radiology unit, especially after the implementation of tariff based on the relative values was much higher than the laboratory Unit. This can indicate a change in the distribution of financial resources between the various para-clinical disciplines

Universal health coverage is an important step towards achieving and benefiting from health services. To measure universal health coverage, appropriate indicators are needed. This study was conducted to select priority indicators for use in general health measurements.
This study is a qualitative study. The population of the research was experts in the country and the sampling was done purposefully. The study was conducted in three stages. In the first phase, 393 indicators related to public health coverage were selected by reviewing texts related to international and domestic indicators and use of expert's opinion, and duplicates were removed. In the second phase, using valid sources such as WHO, Millenium Development Goals, and Sustainable Development Goals of Universal Health Coverage, 100- Core Health Indicators and using expert opinions, 40 indicators were selected for the final survey. In the third stage, 47 experts ranked these 40 indicators.
The most important indicators of universal health coverage from the viewpoints of experts were death rate of pregnant women, vaccination coverage of children under 5 years old, life expectancy at birth, infant mortality rate, death rate of children under 5 years of age, death rate of children under 1 years of age, high blood sugar levels in adults, access to healthy water, death rates due to cancer and general health insurance. Also in the ranking, according to the Healt Indicators of Iran, amoung demographic indicators, death of pregnant women; amoung the indicators of diseases, the coverage rate of vaccinations; amoung the indicators of health coverage, access to healthy water; and amoung the health system indicators, the amount of public insurance coverage were the first priorities.
In general, until the acquisition, more precise determination and prioritization, the indexes ranked among the top ten amoung 40 indciators, and also the first priotity indicator of each of the four components of population and mortality, diseases and risk factors, the coverage of health services, and the health system should be taken into account in reaching the goals of universal health coverage