108 research outputs found
Socioeconomic inequality in exposure to second-hand smoke among middle-aged adults of the RaNCD cohort study: a decomposition analysis
No full textAbstract Background Secondhand smoke (SHS) can cause various health problems among different age groups worldwide. Socioeconomic factors may influence the distribution of SHS exposure among population subgroups. We aimed to estimate socioeconomic inequality in SHS exposure and identify its contributing factors among a sample of Iranian adults. Methods This cross-sectional investigation utilized baseline data from the Ravansar Non-Communicable Disease cohort study. The study population comprised 7991 middle-aged adults aged between 35 and 65 years. To determine socioeconomic status (SES) principal component analysis (PCA) was used. The Wagstaff normalized concentration index (Cn) was utilized to measure the extent of socioeconomic inequality in SHS. Furthermore, decomposition analysis was performed to identify the factors contributing to the observed inequality in SHS exposure. Results The prevalence of SHS exposure among men, women, and the total population was 38.23%, 47.29%, and 43.89%, respectively. The concentration index (Cn) value for SHS exposure was − 0.121 (95% confidence interval [CI]: -0.146, -0.096) in the study participants. Among men and women, the values were − 0.080 (95% CI: -0.122, -0.037) and − 0.095 (95% CI: -0.112, -0.063), respectively, indicating a higher concentration of SHS among individuals with low SES. Female sex (35.17%), socioeconomic status (31.83%), being married (-26.36%), and rural residency (22.44%) were identified as the primary factors contributing to the observed inequality in SHS exposure. Conclusion The research findings revealed a pro-rich inequality in SHS, with a significant concentration among low-SES individuals. In terms of the main contributors to socioeconomic inequality in SHS exposure, policy interventions need to pay attention to females, individuals with low SES, and married individuals to address inequality in SHS exposure
Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran
No full textObjectives Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. Methods This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. Results The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). Conclusions Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population
Sexual health concerns in women with intellectual disabilities: a systematic review in qualitative studies
No full textAbstract Background Studies indicate that women with intellectual disabilities (ID) face various personal and socio-environmental barriers in their sexual lives. This study aimed to identify the concerns and sexual health needs experienced by women with ID. Method A systematic review of relevant qualitative articles was conducted in PubMed, Web of Science Scopus and PsycINFO databases from June 2018 to August 2018. We designed our search strategy according to two main foci: (1) sexuality; and (2) women with ID. In the study, searches were limited to articles published from January 2000 to December 2017. In this review, studies on women ages 16 and over were included. Results Within the four databases, the search found 274 unique articles. After three steps of screening (title, abstract and full text), 22 studies were included in the final review. The articles mentioned difficulties with lack of sexual experience, negative experiences with sexuality, negative attitudes towards sexuality by nondisabled individuals, limited cognitive capacities to understand sexual identity, difficulty with finding the right partner, lack of access to sexual health information, lack of school-based sexuality education, violence and sexual abuse, lack of support from families and caregivers about sexuality, fear of sexual acts and unwanted pregnancy, shyness in expressing sexual desires, and limited knowledge of sexual behaviors. Conclusion Our findings indicate that women with ID need to be provided with school-based sexuality education tailored to the level of understanding needed to attain the requisite knowledge to form relationships, understand sexual and romantic relationships, and practice safe sex when they choose this option. Families along with education and healthcare systems should provide opportunities for women with ID to talk about their sexual needs and make their own choices
Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran
No full textObjectives Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. Methods A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. Results Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p<0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. Conclusions Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals
Healthcare utilization among people with disabilities in Iran: what predictors are associated with medical visits?
No full textAbstract Background Ensuring equitable access to healthcare services for individuals with disabilities poses a significant challenge for healthcare systems. This research aimed to explore the factors affecting medical visits among this population. Method This cross-sectional study in Iran involved data from 766 adults with disabilities aged 18 and older. Unadjusted and adjusted logistic regression analyses were used to calculate the odds ratios for medical visits. Results The majority of participants were male (64.36%) and single (54.02%). In the adjusted model, participants with severe disabilities (OR: 1.901, p = 0.025) were more likely to utilize medical visits compared to those with less severe disabilities. Conversely, individuals in the second (OR: 0.420, p = 0.017), fourth (OR: 0.360, p = 0.004), and fifth (OR: 0.319, p = 0.001) wealth quintiles demonstrated a significantly lower likelihood of accessing medical visits in comparison to the reference group. Conclusions This study reveals critical disparities in healthcare access for individuals with disabilities in Iran. While individuals with severe disabilities demonstrate a higher likelihood of utilizing medical services, those in lower wealth quintiles face significant barriers to accessing care. These findings emphasize the urgent need for targeted interventions to enhance healthcare equity, ensuring that financial constraints do not hinder medical visits for this vulnerable population
Socioeconomic inequalities and dyslipidaemia in adult population of the Ravansar Non-Communicable Disease Cohort Study: the role of sex and age
No full textObjectives This study represents a pioneering attempt to quantify the contribution of age, sex and socioeconomic status (SES) to the observed inequalities in lipid profile components.Design Cross-sectional study.Setting The data from the Ravansar Non-Communicable Disease (RaNCD) Cohort Study were used.Participants 10 000 individuals aged 35–65 years.Main outcome measures Principal component analysis was used to determine the SES of individuals. Using the concentration index (C-index) and curves, the study assessed socioeconomic inequalities in dyslipidaemia in different age groups and genders. Decomposition analysis was used to determine the contribution of sex, age and SES to the observed inequality in the prevalence of dyslipidaemia components between the wealthiest and poorest groups.Results The prevalence of dyslipidaemia was 72.39% of the population and was significantly higher in women than in men (excluding hypertriglyceridaemia). Overall, no significant SES-based inequality in dyslipidaemia was observed (C-index=−0.045, p=0.116), but after adjustment for age and sex, individuals with high SES had increased odds of dyslipidaemia (OR=1.16, 95% CI: 1.03 to 1.31). Hypercholesterolaemia and hyper-low-density lipoprotein (LDL) were more common in individuals with lower SES (C-index=−0.117 and −0.105), while hypo-high-density lipoprotein (HDL) was more prevalent in individuals with higher SES (C-index=0.029), regardless of adjustment for age, sex and confounding factors. SES played a significant role in hypercholesterolaemia and hyper-LDL (322.11% and 400.14%), while sex dominated in hypertriglyceridaemia and hypo-HDL (814.05% and −615.26%) and contributed to the existing inequalities.Conclusion The results highlight the existing inequalities in lipid profiles due to SES, sex and age. Consideration of these factors in interventions and policy decisions is critical to reduce abnormalities and inform future interventions
Willingness to pay for a COVID-19 vaccine and its associated determinants in Iran
No full textINTRODUCTION: Understanding the individuals' willingness to pay (WTP) for the COVID-19 vaccine could help design policy interventions to control the COVID-19 pandemic. This study aimed to estimate the individuals' willingness to pay (WTP) for a COVID-19 vaccine and to identify its associated determinants.METHODS: A cross-sectional survey was conducted on 526 Iranian adults using a web-based questionnaire. A double-bounded contingent valuation approach was used to estimate WTP for the COVID-19 vaccine. The parameters of the model were estimated based on the maximum likelihood method.RESULTS: A considerable proportion of participants (90.87%) were willing to pay for a COVID-19 vaccine. Based on our discrete choice model, the estimated mean WTP for a COVID-19 vaccine was US$ 60.13 (CI: 56.80-63.46; p < 0.01). Having a higher perceived risk of being contaminated with COVID-19, higher average monthly income, higher education level, pre-existence of chronic diseases, previous experience of vaccination, and belonging to higher age groups were significant determinants associated with WTP for COVID-19 vaccination. CONCLUSION: The present study indicates a relatively high WTP and acceptance of a COVID-19 vaccine among the Iranian population. Average monthly income, risk perception, education level, the preexistence of chronic disease, and previous vaccination experience increased the likelihood of WTP for a vaccine. Subsidizing the COVID-19 vaccine for the low-income population and raising risk perception among the population should be considered in formulating vaccine-related interventions.</p
What explains socioeconomic inequalities in dental flossing? Cross-sectional results from the RaNCD cohort study
No full textIntroduction: The magnitude of or determinants underlying socioeconomic inequalities in the use of dental floss is poorly understood in Iran. This study aimed to measure and decompose socioeconomic inequalities in dental flossing in Ravansar, Iran.
Methods: This cross-sectional study used data of 10002 individuals aged 35-65 years obtained from the Ravansar Non-communicable Disease (RaNCD) cohort study located in Kermanshah province, west of Iran. Socioeconomic status was measured through an asset-based method and principal component analysis was carried out to determine the socioeconomic status (SES). The concentration index and curve were used to measure socioeconomic inequality in dental flossing. Decomposition analysis was also used to determine the main determinants that contribute to inequalities in dental flossing.
Findings: Of 10,002 participants, 11.74% were found to use dental floss. The normalized CI for use of dental floss was 0.327 in the entire population, 0.323 in females and 0.329 in males, indicating that the use of dental floss is more concentrated among high-SES individuals. The decomposition analysis indicated that SES (50.58%) and level of education (44.90%) respectively contributed the most to this inequality. Place of residence (10.55%) and age group (2.7%) were the next main contributors, respectively.
Conclusion: There are a low prevalence and a relatively high degree of pro-rich socioeconomic-related inequality in dental flossing among Iranian adults. Socioeconomic status, level of education and place of residence contributed the most to the observed inequalities in dental flossing. Policy interventions should consider these factors to reduce inequality in the use of dental floss and increase the prevalence of dental flossing.
 
An Insight Into Perceptions of Speech-language Pathologists About the Barriers to Providing Online Speech-language Therapy in Iran
No full textObjective The advancements in communication and information technology have brought about significant changes in the provision of healthcare services, including speech-language therapy. In this regard, telehealth has recently emerged as an accessible and effective method. The present study aims to identify the challenges of providing online speech-language therapy services in Iran from the perspective of speech-language pathologists.
Materials & Methods This qualitative study was conducted from 2021 to 2022. Snowball sampling was used to select 14 speech-language pathologists (10 females and 4 males) with a mean age of 29 years and at least one year of experience in providing online services during the COVID-19 pandemic. Data were collected using semi-structured interviews, conducted individually by audio and video calling on messaging apps (WhatsApp and Skype). Data analysis was done using the thematic data analysis method.
Results Six themes emerged: Lack of educational/professional guidelines (lack of academic training related to the provision of online speech therapy services, and absence of clear guidelines for conducting online speech therapy), socio-cultural issues (interference of work with personal life, and informality of online sessions), communicational/interactional challenges (lack of face-to-face interaction with patients, slow internet speed for communication and data transmission, poor video quality in Iranian apps, distraction and increased inclination of children to play with phones, filtering of foreign messaging apps, inadequate internet coverage in some rural and urban areas, and lack of specialized and official apps for online service delivery), financial barriers (inability of some families to afford internet packages and suitable phones, unwillingness of some families to pay high fees for online speech therapy, and unclear pricing for online speech therapy services), decreased quality of patient assessment/treatment (inability to correctly implement certain therapeutic techniques, inaccurate assessment of children, incorrect diagnosis of speech-language disorders, lack of accurate recognition of the child’s abilities, failure to hold group therapy sessions, the use of diagnostic and therapeutic tools, and increased fatigue and burnout for therapists and families), and lack of supervision over therapy sessions (involvement of non-professionals in online therapy, and neglect of patient rights).
Conclusion Various structural, professional, cultural, and ethical barriers can hinder the delivery of online speech-language therapy services in Iran. Providing educational programs in medical universities, developing essential guidelines to protect the rights of therapists and patients, designing specialized and efficient apps, and establishing proper communication infrastructure can facilitate the online provision of these services in Iran
Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: a decomposition analysis
No full textAbstract Background Persons with disabilities (PWD) generally experience various barriers in using health care compared to the general population, and these problems are more worsened for those with disabilities in lower socioeconomic status. The study aimed to estimate socioeconomic inequality in using rehabilitation services (URS) in adults with disabilities in Iran. Methods This cross-sectional study was conducted at a national level in Iran. 786 PWD (aged 18 years and older) participated in the study between September and December 2020. Socioeconomic-related inequality in URS was estimated by the Concentration Index (C). The C was decomposed to identify factors explaining the variability within the socioeconomic inequality in URS. Results In the present study 8.10% (N = 61) of the study population used rehabilitation services during the past three months. In this study, the value of the C was estimated 0.25 (p-value = 0.025) that shows URS was unequally distributed, and concentrated among the higher SES groups. The results of decomposition analysis indicated that the wealth index was the largest contributor (94.22%) to the observed socioeconomic inequalities in URS among PWD. Following the wealth index, Age and marital status were the major contributors to the unequal distribution of URS among the study population. Conclusions Our findings revealed that socioeconomic inequality in using rehabilitation services was concentrated among well-off PWD. Accordingly, rehabilitation financing through appropriate mechanisms for individuals with low SES is suggested
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