Perceived social support and maternal competence in primipara women during pregnancy and after childbirth

Background: Developing maternal competence in first time mothers has a significant impact on neonate's growth psychosocial development and neonates growth and psychological development. Social support can be an important element for becoming a new mother. We aimed to investigate how social support and maternal competence change during pregnancy and 4 months after it and examine the relationships among social support and maternal competence

Methods: This longitudinal study was conducted on 100 first time mothers attending health centers in Alborz city, Alborz Province, between February 2015 and January 2016. Data were collected through perceived social support questionnaire that consisted of 12 questions and Parenting Sense of Competence Scale consisting of 17 items scored based on Likert's scale. The collected data were analyzed by SPSS software, version 16. Repeated-measure test and Pearson's correlation coefficient were used. P<0.05 was considered significant

Results: Maternal competence significantly reduced during the study [P=0.008], while perceived social support did not show any significant reduction [P=0.286]. A direct relationship was found between social support and maternal competent six weeks after childbirth [r=0.19, P=0.049], and also social support and maternal competence sixteen weeks after childbirth [r=0.23, P=0.01]

Conclusion: Considering the reduction of maternal competency during the study, social support by healthcare providers may be helpful for the mothers' transition to motherhood, and midwives must design specific interventions to promote the sense of maternal competence and perceived social support in first time mothers

Echocardiographic Assessment of Pulmonary Arteries Pulsatility Index in Fontan Circulation

BACKGROUND: Late complications after Fontan procedure may be due to the absence of pump and pulsatile pulmonary blood flow in this type of palliation. Our aim was to quantify the degree of pulsation by echocardiographic method in patients with extracardiac total cavopulmonary connection (ECTCPC) in comparison with biventricular circulation and few cases of pulsatile Fontan. METHODS: In a case series study, pulsatility index (PI) derived by echocardiographic method were compared between 20 patients with ECTCPC, 6 patients with pulsatile Fontan and 18 normal individual aged 4 to 20 years old. All patients were in New York Heart Association class of I and there was no report of complication. RESULTS: In patients with ECTCPC pulmonary artery branches Doppler flow study showed lower peak and mean velocities compared to the pulsatile Fontan and normal groups. ECTCPC patients had PI of 0.59 +/- 0.14 and 0.59 +/- 0.09 for right and left pulmonary arteries (RPA and LPA) respectively. PI was higher in patients with preserved antegrade flow (RPA PI = 0.94 +/- 0.26, LPA PI = 0.98 +/- 0.27) and in normal individuals (RPA PI = 1.59 +/- 0.12, LPA PI = 1.64 +/- 0.17) for both branches (p = 0.000). CONCLUSION: Using a Doppler derived index for pulsatility, patients with ECTCPC had the least pulsation. The pulmonary artery flow pattern in patients with preserved antegrade flow showed higher pulsatility indices in both branches. Normal individuals had the greatest pulsatility index.

Sample size calculation in medical studies

Optimum sample size is an essential component of any research. The main purpose of the sample size calculation is to determine the number of samples needed to detect significant changes in clinical parameters, treatment effects or associations after data gathering. It is not uncommon for studies to be underpowered and thereby fail to detect the existing treatment effects due to inadequate sample size. In this paper, we explain briefly the basic principles of sample size calculations in medical studies

[Assessment of factor effectiveness on the bilateral corneal graft rejection in the keratoconus with cure frailty model]

Although corneal graft may be rejected by the immune system of the recipient it remains as the most successful operation as compared to transplantation of other tissues. Since most patient do not reject the grafts, those who do are in the minority. This study was carried out to assess the usefulness of the cure frailty model for determining the significance of risk factors associated with the rejection of bilateral corneal transplants in patients with keratoconus. Patients with keratoconus receiving bilateral corneal transplants were included in the study. For analysis of the time of bilateral graft rejection in the keratoconus disease we used the cure frailty model and the promotion time cure frailty and used the Cox frailty model for comparison. For estimating the parameters we used the Bayesian approach. For comparison of proposed models we used the Deviance Information Criteria [DIC]. 238 individuals received corneal transplants during the study period and 22.7 percent experienced graft rejection. Mean and median of graft rejection time was 13.5 +/- 22.8 and 6.9 months respectively. Vascularization and old age were important risk factors for graft rejection. In the cure frailty model the cure rate in the patients with vascularization were 34 percent versus 75 percent without vascularization. In the time promotion cure frailty model the cure rates in cases with vascularization were 32 percent and without vascularization were 70%. The cure models that include the parameter for cure rate in the comparison to the Cox frailty model that do not have parameters for cure rate are better for data analysis. For analysis of survival data in which selection of patients is highly selected using the cure model gives more accurate results