Exploring the Contributory Factors of Confined Space Accidents Using Accident Investigation Reports and Semistructured Interviews

BACKGROUND: The oil and gas industry is one of the riskiest industries for confined space injuries. This study aimed to understand an overall picture of the causal factors of confined space accidents through analyzing accident reports and the use of a qualitative approach. METHODS: Twenty-one fatal occupational accidents were analyzed according to the Human Factors Analysis and Classification System approach. Furthermore, thirty-three semistructured interviews were conducted with employees in different roles to capture their experiences regarding the contributory factors. The content analyses of the interview transcripts were conducted using MAXQDA software. RESULTS: Based on accident reports, the largest proportions of causal factors (77%) were attributed to the organizational and supervisory levels, with the predominant influence of the organizational process. We identified 25 contributory factors in confined space accidents that were causal factors outside of the original Human Factors Analysis and Classification System framework. Therefore, modifications were made to deal with factors outside the organization and newly explored causal factors at the organizational level. External Influences as the fifth level considered contributory factors beyond the organization including Laws, Regulations and Standards, Government Policies, Political Influences, and Economic Status categories. Moreover, Contracting/Contract Management and Emergency Management were two extra categories identified at the organizational level. CONCLUSIONS: Preventing confined space accidents requires addressing issues from the organizational to operator level and external influences beyond the organization. The recommended modifications provide a basis for accident investigation and risk analysis, which may be applicable across a broad range of industries and accident types.

Modeling in vitro fertilization data considering multiple outcomes observed among Iranian infertile women

Background: Women undergoing in vitro fertilization [IVF] cycles should successfully go through multiple points during the procedure [i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery] to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women

Materials and Methods: This historical cohort study includes 996 assisted reproductive technology [ART] cycles of 511 infertile women. Covariates considered in this study were women's age, type of cycle [fresh or frozen embryo transfer], number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio [OR] and 95% confidence intervals [95% CI] of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations [CWGEE] was also fitted to handle informative cluster size

Results: After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer [adj OR: 2.26, 95% CI: 1.66-3.07]; however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category [<35] in CWGEE model [adj OR: 0.67, 95% CI: 0.45-1.00]. The number of embryos transferred was positively associated with the odds of success in CWGEE [adj OR: 1.21, 95% CI: 1.03-1.42] as well as the GEE model

Conclusion: Receiving frozen embryo was positively associated with odds of success compared to cycles with fresh embryo. The number of embryos transferred and women's age were significantly associated with odds of success

Women's sexual and reproductive health care needs assessment: an Iranian perspective

Background: Reproductive health problems are a leading cause of women's ill health and mortality worldwide. There is a need to investigate sexual and reproductive health care needs in different societies and cultural contexts. Despite the success in health care promotion in the Iranian health care system, women still need to receive sexual health care and appropriate HIV/AIDS services. However, studies on the sexual and reproductive health care needs of Iranian women are lacking.

Aims: This study aimed to investigate the sexual and reproductive health care needs of women referred to health care centres in an urban area of the Islamic Republic of Iran.

Methods: We carried out a cross-sectional study in 2013 on 514 women living in an urban area in the north of the Islamic Republic of Iran. Taking into consideration ethical principles, data were collected using the Sexual and Reproductive Health Care Needs Assessment Questionnaire.

Results: The findings showed a greater need for the provision of care by practitioners in the sexual history and activities domain [73%] compared with other domains. Also, the woman's age and the location where she sought treatment and care for sexually transmitted infections were predictors of sexual activities needs.

Conclusions: Owing to the high prevalence of women's referral to health care centres seeking treatment of sexual disorders, there is a need for the provision of sexual counseling centres and services promoting women's reproductive health care

Barriers to pap smear test for the second time in women referring to health care centers in the South of Tehran: a qualitative approach

Background: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear

Methods: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time

Results: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms

Conclusion: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women

Predictors of physical activity among adolescent girl students based on the social cognitive theory

Background: The importance of increasing adolescence girl's level of physical activity is recognized as a priority for having a healthy lifestyle. However, adolescent girls especially Iranian, are at high risk for physical inactivity. Social Cognitive Theory [SCT] is a successful theory to explain physical activity behavior. The aim of this study was to determine the predictors of physical activity based on the SCT

Methods: This cross-sectional study was conducted among 400 adolescent girls [15-16 yr old] in Tehran, Iran [2013]. The participants were randomly chosen with multistage sampling. The SCT constructs consisted of self-efficacy, self-regulation, social support, outcome expectancy, and self-efficacy to overcoming impediments. Statistical analysis was carried out applying SPSS: 16, LISREL 8.8. Stepwise regression was used to test predictors of behavior. Pearson correlation was assessed

Results: Self efficacy to overcoming impediments was the main construct to predict physical activity [Beta=0.37]. Other determinants were self-efficacy [Beta=0.29], family support [beta=0.14], outcome expectancy [beta=0.13], friend support [beta=0.12], and self-regulation [beta=0.11], respectively. In general, the SCT questionnaire determined 0.85 variation of physical activity behavior. All of the constructs had direct significant relation to physical activity behavior [P<0.001]

Conclusions: The constructs of SCT provide a suitable framework to perform promoting physical activity programs and self-efficacy to overcoming impediments and self-efficacy are the best predictors of physical activity in adolescent girls

Structural modeling of safety performance in construction industry

With rapid economic development and industrialization, the construction industry continues to rank among the most hazardous industries in the world. Therefore, construction safety is always a significant concern for both practitioners and researchers. The objective of this study was to create a structural modeling of components that influence the safety performance in construction projects. We followed a two-stage Structural Equation Model based on a questionnaire study [n=230]. In the first stage, we applied the Structural Equation Model to the proposed model to test the validity of the observed variables of each latent variable. In the next stage, we modified the proposed model. The LISREL 8.8 software was used to conduct the analysis of the structural model. A good-fit structural model [Goodness of Fit Index=0.92; Root Mean Square Residual=0.04; Root Mean Square Error of Approximation=0.04; Comparative Fit Index=0.98; Normalized Fit Index=0.96] indicated that social and organizational constructs influence safety performance via the general component of the safety climate. The new structural model can be used to provide better understanding of the links between safety performance indicators and contributing components, and make stronger recommendations for effective intervention in construction projects

Opinions of the midwives about enabling factors of skin-to-skin contact immediately after birth: a descriptive study

Despite the benefits of mother-newborn skin-to-skin contact [SSC] immediately after birth, the process has not been universally implemented as routine care for healthy term neonates. The purpose of this study was to determine opinions of the midwives about enabling factors of SSC immediately after birth in Tehran hospitals in 2012- 2013. This study has been conducted in a descriptive method based on PRCEDE-PROCEED model. The samples were 292 midwives from 18 hospitals. We used stratified and then simple random sampling. In this study midwives were working at delivery room; deliveries were conducted by midwives or they were in charge of the newborn immediately after birth. Data collection instrument was a self developed questionnaire concerning the enabling factors in the SSC. We applied face and content validity ratio [CVR], content validity index [CVI] and item impact method for the instrument's validity and Cronbach's Alpha for reliability. Finally, data were analyzed and interpreted using spss-18 through descriptive statistics. The results show that 90.4% of the midwives believed in necessity of a plan, 96.2% believed that good services should be provided to mothers, and 97.9%, 85.3% and 93.8% of them believed there is a need for private space, essential facilities and essential equipment for skin contact process; with Cronbach's Alpha of 0.731, 0.551, 0.501, and 0.600 respectively. Most of the midwives believed that enabling factors concerning the successful SSC are effective. We suggest further studies on other enabling factors effective in SSC from the view point of midwives, gynaecologists and caregivers

Development and psychometric properties of [Iranian Diabetic Adolescent Girl's Quality of Life] questionnaire

Diabetes with permanent changes in a person's lifestyle may influence diabetic adolescent quality of life [QOL] negatively. Studies conducted on diabetic patients are increasingly measuring patient-centered outcomes such as functional status and health-related QOL [HRQOL]. The development of a HRQOL questionnaire with an optimal measuring performance provides nurses with a standardized assessment tool in order to determine the impact of the disease on diabetic adolescent girl's activity daily living. This study aimed to develop and assess psychometric properties of [Iranian Diabetic Adolescent Girl's QOL [IRDAGQOL]] questionnaire. The items and content of [IRDAGQOL] questionnaire were generated from themes and items extracted from a qualitative study using content analysis approach with the participation of 20 adolescent girls with diabetes. Face validity of questionnaire with the participation of 10 adolescent girls and content validity by 15 experts, was approved. Convergent and discriminant validity of questionnaire confirmed. Exploratory factor analyses using principal component extraction method was performed to determine the questionnaire domains. The Cronbach's coefficient alpha was calculated to determine the instrument internal consistency in 250 samples. In 30 samples, using SPSS statistical package, test re-tests after 2 weeks confirmed questionnaire reliability. The patient interviews allowed for the identification of 50 items in the final questionnaire. Principal components analysis revealed the presence of five components that jointly accounted for 79.945% of the variance. The face and content validity processes resulted in an approved and valid questionnaire. Reliability analysis showed satisfactory result [Cronbach's alpha = 0.870]. The findings showed that the [IRDAGQOL] questionnaire presented in this study is a valid and reliable instrument that can be used for measuring adolescent girl's QOL

[Psychometric properties of questionnaire of predicting factors for dental caries in adolescents: Fitness theory through factor analysis]

Background: There is an absence of a valid and reliable tool basedon a field study for predictingfactors related to dental caries in adolescents. Also the lack of preventivemodels of tooth decay has been perceived. The aim of thisstudy was to design preventive models by assessing psychometric properties of questionnaire of predictive factors for dental caries inadolescents using factor analysis.

Materials and Methods: This descriptive analytical research was done in 2013-14onadolescents who lived in Tehran city.First, model and questionnaire of predictive factors for dental caries in adolescents were designed based on qualitative research using grounded theory. Using systematic samplings, 607 studentsand 400 students [12 and 16 years old] were selected for Exploratory Factor Analysis and Confirmatory Factor Analysis respectively. The reliability of the questionnairewas calculated by two different

methods: Cronbach'salphaand test-retest. Also, in order to determine the validity of the scale, we used three methods including face validity, content validity, and construct validity. Exploratoryand ConfirmatoryFactorAnalysis were done bySPSS softwareversion 16 and LISLER softwareversion 8.8 respectively. Finally, appropriate models for preventing of tooth decay were presented.

Results: During exploratory factor analysis, eightfactors developed: behavioral factors, fear, social support, motivational beliefs, role of school, instructive elements, socio – economic status, and value of teeth. Results of confirmatory factor analysis showed that the eightfactor model for preventing of dental caries fit Iranian adolescents and the four-factor model isthe strongest predictor of oral health behaviorwhich foresees 76% of behaviors related to oral and dental health.Also test-retest scoreobtained 0.74 and internal consistency was 0.85.

Conclusion:Based on the results of this study, the validity and reliability of the38-item questionnaires of predictive factors for dental caries in adolescents is acceptable and suitable. Therefore the presented models can be used in designing educational programs. Also this tool can be applied in future researches and different groups of students.

Modeling the factors affecting unsafe behavior in the construction industry from safety supervisors' perspective

There can be little doubt that the construction is the most hazardous in-dustry in the worldwide. This study was designed to modeling the factors affecting un-safe behavior from the perspective of safety supervisors. The qualitative research was conducted to extract a conceptual model. A structural model was then developed based on a questionnaire survey [n=266] by two stage Structural Equation Model [SEM] approach. An excellent confirmed 12-factors structure explained about 62% of variances unsafe behavior in the construction industry. A good fit structural model indicated that safety climate factors were positively correlated with safety individual factors [P<0.001] and workplace safety condition [P<0.001]. The workplace safety condition was found to play a strong mediating role in linking the safety climate and construction workers' en-gagement in safe or unsafe behavior. In order to improve construction safety performance, more focus on the workplace condition is required.

Modeling the recurrent failure to thrive in less than two-year children: recurrent events survival analysis

This study aimed to evaluate the failure to thrive [FTT] recurrent event over time. This longitudinal study was conducted during February 2007 to July 2009. The pri-mary outcome was growth failure. The analysis was done using 1283 children who had experi-enced FTT several times, based on recurrent events analysis. Fifty-nine percent of the children had experienced the FTT at least one time and 5.3% of them had experienced it up to four times. The Prentice-Williams-Peterson [PWP] model revealed significant relationship between diarrhea [HR=1.26], respiratory infections [HR=1.25], urinary tract infections [HR=1.51], discontinuation of breast-feeding [HR=1.96], teething [HR=1.18], initiation age of complementary feeding [HR=1.11] and hazard rate of the first FTT event. Recurrence nature of the FTT is a main problem, which taking it into account increases the accuracy in analysis of FTT event process and can lead to identify different risk factors for each FTT recurrences.

survey on midwives' opinions about skin to skin contact between mother and newborn, immediately after birth; a cross- sectional study

Successful breast feeding, especially using breast crawl in the first 5 minutes after birth, is one of the important factors for newborn's health. Breast crawl is the way that can reduce newborns death rate; however it is not widely used in Iran. In this Analytic cross-sectional study, stratified sampling was applied to recruit 150 midwives from 16 hospitals who are responsible for delivery or newborns immediately after birth. Data collection was conducted using nineteen focus group discussion consisted of 6-12 participants. Discussions were held in hospitals' calm environment for about 1:45' - 2 hours. Also, a questionnaire was used as an instrument for collecting demographic information. Instructional leaflets, composed of five questions were distributed among the participants. The instruments' validity was assessed through CVI and CVR methods. Content analysis, descriptive statistics and Chi-Square test were conducted in SPSS-18 to analyze the data. The findings of the research reveal that 98% of the midwives have used skin-to-skin contact from at least two to four minutes. Moreover, 58.9% and 57.4% of the obstetricians have considered the contact as breast crawl in educational and non-educational hospitals, respectively; 58.9% and 53.2% of them have used skin-to-skin contact whenever possible; 28.6% and 23.4% have placed the newborns on their mother's abdomen to perform breast crawl; 44.6% and 33.3% applied such contact immediately afterbirth; and 67.9% and 85.1% are satisfied with their workplace environment, respectively. The results show that midwives are familiar with skin to skin contact and its benefits for both mother and newborn. However, they do not employ this method immediately after birth. There is an urgent need for more qualitative and quantitative studies to investigate the inhibitory factors

[Translation and validation study of the Iranian version of Seattle Angina questionnaire]

Objective [s]: To translate and evaluate the validity and reliability of the Seattle Angina Questionnaire, as a disease-specific quality of life scale in patients with angina pectoris

Method: After permission, the questionnaire was translated. Then face validity, content validity, concurrent validity and criterion validity were determined. In order to evaluate the construct validity, known-groups comparison [patients with and without chest symptoms] was performed and to determine its criterion validity the Short Form 36 [SF-36] was used. Cronbach's alpha coefficients and the test retest were used to assess the scale reliability. 100 patients with angina pectoris participated in this study

Results: The criterion validity showed high and significant correlation between most SAQ and SF-36 scores. Cronbach's alpha of the total scale was 0.85 and test-retest reliability [ICC] within 2 weeks, in all dimensions was greater than 0. 90

Conclusion: The findings suggest that the SAQ is a valid and reliable disease-specific scale and can be considered for measuring health outcomes in research and clinical settings

[Living with HIV: a qualitative research]

Objective [s]: To investigate on consequences of living with HIV/AIDS

Methods: This was a qualitative study. Initially we selected a convenience sample and then narrowed-down the sample by maximum diversity in terms of age and education. Data was collected via semi-structured interviews. All interviews were recorded and transcribed, and the codes were extracted after reviewing them several times. Content analysis was performed to explore the data

Results: In all 34 participants were interviewed: 32 HIV positive men [with age average: 37.5 years and standard deviation: 7.13] and 4 HIV positive women [with age average: 34 years and standard deviation: 3.04] Participants indicated the following consequences: social, psychological, physical and economic. Most participants referred to adverse social outcome as the most important consequences of living with HIV/AIDS. The most important social adverse effect mentioned by participants was stigma, discrimination and exclusion

Conclusion: The findings suggest that stigma and discrimination should be lessening for people who live with HIV/AID. Perhaps media could play an important role to achieve this

Causes of dental caries from the perspectives of adolescents: a qualitative study

Objective: Various factors affect dental caries and impact the patterns of dental care. A few studies have been conducted to identify these factors from the perspectives of students. This study aimed to explore factors influencing dental caries from students' perspectives

Methods: A qualitative design using content analysis approach was conducted to collect the perspectives of 18 Iranian students who were studying in 8 guidance schools. They were chosen through purposive sampling. Semi- structured private interviews and focus groups were held for data gathering. The tape-recorded interviews were transcribed verbatim and analyzed using an inductive content analysis approach. In order to support the validity and rigor of the data, different trustworthiness criteria such as acceptability, confirm ability and transferability were considered

Results: During data analysis, four main categories were developed: "difficult conditions of care", "disability in caring", "uncontrollability of dental caries" and "intangible sense of the factors causing dental caries"

The participants more emphasized their own experiences about having insufficient dental-oral care, not paying attention to oral health, dental fear and the lack of both knowledge and competency regarding this issue

Conclusion: The findings of this study revealed factors influencing dental caries from students' perspectives and emphasized the roles of individual, parent, dentist and community in this respect

The findings of this study can be considered to be a valuable basis to design oral health interventions. However, more studies are required to improve our understanding of dental fear and denote barriers and social beliefs pertinent to oral health in different groups of students?

[Socio-environmental barriers of condom use among women at risk for HIV/AIDS: a qualitative study]

Objective [s]: To explore barriers of condom use among women at risk for HIV/ AIDS

Methods: Grounded theory approach has been implemented for data gathering and analysis. Participants were 22 women at risk [homelessness and/ or drug abuser, multi partners and/or having husband with one or more condition as below: HIV positive and/or IDUs drug user, extramarital relationships]. Twenty-five semi-structured interviews were conducted with a purposive sample of at risk women aged 21 to 49 years at VCT Centers or DICs in Tehran. Qualitative content analysis of the data was conducted manually and was guided by constant comparative analysis

Results: The major themes emerged were; insufficient social support, poverty and economic factors, drug abuse, and some socio-cultural norms such as gender roles

Conclusion: Findings can be implemented for effective HIV/ AIDS prevention strategies and interventions

qualitative evaluation o men living with HIV: views on codom use

Unprotected sexual activity is an important reason for the currently growing incidence of HIV infection in Iran. Recognizing barriers to safe sexual practice and affordance of behavioral changes can improve planning for condom promotion. The main objective of our study is to evaluate the opinions of HIV-positive men on condom use. Our study was performed at three behavioral disease consultation clinics [HIV care clinics] in Tehran, Iran. Participants were initially selected among HIV-positive male patients by convenience sampling and narrowed-down by maximum diversity sampling in order to obtain the number of patients that would express various viewpoints regarding barriers and benefits to condom use. Data were collected using in-depth semi-structured individual interviews. All interviews were recorded and transcribed, and the codes were extracted after reviewing them several times. In this study, 22 HIV-positive men with a mean age of 37.5 +/- 7.3 years were interviewed. Participants mentioned the prevention of HIV and sexually transmitted diseases as a benefit of condom use. However, most named decreased sexual satisfaction as the most important reason for not using condom. Because of decreased sexual satisfaction and unpleasantness, 9% of participants had not used condom during sexual intercourse. The most important reason for not using condom was decreased sexual satisfaction. This study was indicated a need for consultations with HIV-positive and at risk populations to change their attitudes towards condom use and demonstrate the advantages of condom. To achieve this, government programs and media should be utilized

Prediction of exercise behavior among college students based on transtheoretical model [TTM] using path analysis

To determine the efficacy of the TTM to predict exercise behavior in a sample of Iranian college students. This was a cross-sectional study. Participants were 418 first year students of Guilan University of Medical Sciences who completed Iranian versions of the TTM and exercise behavior questionnaires. Data were analyzed using bivariate correlation and path analysis. In the final model, path coefficient for the processes of change [behavioral strategy], self-efficacy in exercise and pros were 0.54, 0.20 and -0.11 respectively. The model accounted for 38% of the variance for predicting current exercise behavior. The study findings support the application of TTM in exercise behavior changes among Iranian students

[Comparison of influential factors affecting survival of patients with colon and rectum cancer using competing risks model]

Colorectal cancer is the most common cancer of digestive system and also fourth cause for death of cancer around the world. Different studies indicate that survival of patients suffering from colorectal cancer has recently developed in some areas of the world. However, it is not clear which factors involve in this improvement. This study aims at investigating some clinical and pathologic factors in prognosis of these patients with colon and rectum cancers separately. Data recorded from 1194 patients with colorectal cancer in Cancer Record Center of Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences [Tehran, Iran] was used in this study. Data analysis was performed using competing risks model. Software used for data analysis was STATA, 11 version, and significance level was regarded as 0.05. Body mass index, alcohol consumption, tumor site, inflammatory bowel disease, metastasis to lymph nodes and metastasis to other organs had significant effect on death of colon cancer, while body mass index, metastasis to other organs and kind of the first treatment had significant effect [P<0.05] on rectum cancer. Median survival was 7.75 +/- 1.118 and 3.917 +/- 0.26 years for patients with colon cancer and rectum cancer respectively. Also, 1, 2, 3, 4 and 5 years of survival rates for colon cancer were 88.7%, 77.9%, 68.5%, 61.4% and 56.8%, respectively, while they were 89.1%, 74.2%, 60.7%, 47.1% and 41.9% for rectum cancer, respectively. According to the results of this study, some variables may have different impacts on colon and rectum carcinoma; therefore it is needed that the effects of the factors on different parts of the large bowel be considered separately in the future studies

Imputation in missing not at random SNPs data using EM algorithm

The relation between single nucleotide polymorphisms [SNPs] and some diseases has been concerned by many researchers. Also the missing SNPs are quite common in genetic association studies. Hence, this article investigates the relation between existing SNPs in DNMT1 of human chromosome 19 with colorectal cancer. This article aims is to presents an imputation method for missing SNPs not at random. In this case-control study, 100 patients suffering from colorectal cancer consulting with the Research Institute for Gastroenterology and Liver Disease of Shahid Beheshti University of Medical Sciences were considered as the case group and 100 other patients consulting with the same research institute were considered as the control group and the genetic test was applied in order to identify the genotype of the 6 SNPs of the DNMT1 of chromosom 19 for all the patients under investigation. The obtained data were analyzed using logistic regression, then a fraction of the data was eliminated both at random and not at random and the imputation was done through the EM algorithm and the logistic regression coefficients variation before and after the imputation was compared. The results of this study implied that in both methods, at random and not at random missing SNPs, the estimation of the logistic regression coefficients after the imputation through EM algorithm has a greater correspondence to the results obtained from the complete data in comparison with the method of eliminating the missing values