Effect of educational intervention on self-efficacy for choosing delivery method among pregnant women in 2013

Nowadays, there has been a growing trend of caesarean sections in Iran. One reason would be the mother's desire. Increased maternal self-efficacy can be an important step to reduce percentage of cesarean. This study aimed to determine the effectiveness of training-based strategies to increase the self-efficacy for choosing delivery method among pregnant women in Shahrekord city. This quasi-experimental study was conducted on 130 pregnant women who attended urban health centers in Shahrekord city in 2013. Intervention was applied in the experimental group in three sessions in about 60-90 min while control group did not receive any intervention. Fear of childbirth and self-efficacy questionnaire was completed before and after training. While mean scores of the fear of childbirth, expectations and childbirth self-efficacy before the intervention between the two groups were not significantly different [P > 0.05], mean scores of childbirth in intervention group was reduced and expectation and childbirth self-efficacy had a significant increase after intervention [P < 0.05]. In this study, 71.4% of mothers in intervention group and 53.8% of control mothers naturally delivered their children. Most of intervention group mothers desired to deliver through cesarean and had more fear [P < 0.001] but lower childbirth expectation [P> 0.05] and self-efficacy [P < 0.001] than those who chose normal method. Our findings showed that training-based self-efficacy procedure has been effective in encouraging mothers to choose natural childbirth. Therefore, the design and implementation of curriculum-based strategies for increasing self-efficacy is suggested for pregnant women

Distribution of mortality among 1 - 59 month-old children across Iranian provinces in 2009: the national mortality surveillance system

To determine the distribution of mortality in 1 - 59 month-old children across Iranian provinces in a national mortality surveillance system. This national survey was conducted in 2009. A questionnaire was designed and standardized for collecting mortality data of children aged 1 - 59 months. The project team, consisting of collaborators from the whole 40 medical universities, filled in the questionnaires and returned them to the Ministry of Health and Medical Education [MOHME]. The mortality in 1 - 59 month-old children was unequally distributed across provinces. The mortality was higher among children of less- educated mothers than in children of more- educated mothers. There was a reverse association between 1 - 59 months mortality and socioeconomic status across Iran as a whole and within most provinces. Our results suggest that socioeconomic distribution in mortality of 1 - 59 month-old children favors the better-off in Iran as a whole and in most of its provinces. Investigating why mortality is higher in some provinces deserves special attention. Furthermore, it is advisable to conduct provincially-representative surveys to provide update estimates of different health situations and to allow their monitoring over time

Inequality in school readiness and autism among 6-year-old children across Iranian provinces: national health assessment survey results

To assess the national inequality of school readiness and autism among 6-year-old Iranian children before school entry using a national health assessment survey. In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. The study population consisted of 955388 children [48.5% girls and 76.1% urban residents]. Of the whole children 31% of the 6 year old children had impaired vision In addition, 1.2, 1.8, 1.4, 7.6, 0.08, 10, 10.9, 56.7, 0.7, 0.8 and 0.6 percent had color blindness, hearing impaired, speech disorder, school readiness, autism, height to age retardation, body mass index extremes, decayed teeth, disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Our results confirmed that there is an inequality in distribution of school readiness and autism in 6-year-old children across Iranian provinces. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identity the reason for different inequality among provinces

Mortality inequality in 1-59 months children across Iranian provinces: referring system and determinants of death based on hospital records

To determine inequality in mortality in 1-59 months children across Iranian provinces focusing on referring system and determinants of death. After designing and examining a national questionnaire for mortality data collection of children 1-59 months, 40 medical universities have been asked to fill in the questionnaires and return to the main researcher in the health ministry in 2009. Mortality in 1-59 months children was unequally distributed across provinces [universities]. The recommended refer was 3466 but only 1620 patients were referred. The first five important determinants of death were congenital [671 children or 20.9%], accident [547 children or 17.1%], pulmonary diseases [370 children or 11.5%], cardiovascular [266 children or less than 8.3%], central nervous system [263 children or 8.2%], and infectious and parasitic diseases [245 children or 7.6%], respectively. Our results suggest that inequality in 1-59 months mortality based on the hospital records, and specially referring system, needs more attention in Iran. In addition, it is advisable to conduct provincially representative surveys to provide recent estimates of hospital access inequalities and to allow monitoring over time

Comparison of models for predicting outcomes in patients with coronary artery disease focusing on microsimulation

Physicians have difficulty to subjectively estimate the cardiovascular risk of their patients. Using an estimate of global cardiovascular risk could be more relevant to guide decisions than using binary representation [presence or absence] of risk factors data. The main aim of the paper is to compare different models of predicting the progress of a coronary artery diseases [CAD] to help the decision making of physician. There are different standard models for predicting risk factors such as models based on logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. Each model has its own application which can or cannot use by physicians to make a decision on treatment of each patient. There are five main common models for predicting of outcomes, including models based on logistic regression model [for short-term outcomes], Cox regression model [for intermediate-term outcomes], dynamic logistic regression model, and simulation models such as Markov and microsimulation models [for long-term outcomes]. The advantages and disadvantages of these models have been discussed and summarized. Given the complex medical decisions that physicians face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, physicians may potentially benefit from a clinical decision support system that accounts for all these considerations. The microsimulation model could provide cardiologists, researchers, and medical students a user-friendly software, which can be used as an intelligent interventional simulator

Zinc and copper status in children with high family risk of premature cardiovascular disease.

Zinc and copper are beneficial to health, growth and development, and also for the prevention of cardiovascular disease [CVD] with regards to improved dietary habits as a preliminary step in CVD prevention. This study was conducted among 2-18-year-old children with high family risk of premature CVD in comparison to controls. Subjects and One hundred randomly selected children whose parents had premature myocardial infarction were included in the study. The controls were 100 individuals randomly selected from the case group's neighbors and matched for age, sex and socioeconomic status. A four-day food record questionnaire was used to assess zinc and copper intakes, and their serum levels were determined using Flame-Atomic Absorption Spectrophotometry. The data were analyzed by SPSS/Windows V6 software, using the Student's t and Mantel-Hanzel tests. Significance of differences was considered at P<0.05. The daily zinc intake was significantly lower in the case than control group [6.89 +/- 2.97 vs. 8.30 +/- 2.45 mg, P=0.047]. The mean serum zinc level was not significantly different between both groups [82.12 +/- 14.1 vs. 92.26 +/- 23.7 micro g/dL, P>0.05]. Zinc deficiency was more prevalent among the case in boys than their controls [58% vs.18%, P=0.04]. This difference was not significant in girls [44% vs. 40%]. The daily intake and serum level of copper were not significantly different between the case and control groups. No case of copper deficiency was found. The mean systolic blood pressure was not significantly different between the zinc-deficient and zinc-sufficient subjects. Although the mean diastolic blood pressure of the former was higher than the latter, there was no statistically significant difference. About 23.7% of all studied sample had mild-to-moderate degrees of failure to thrive, with significantly lower daily intake and serum zinc level than other subjects [5.41 +/- 1.06 mg, 82.09 +/- 12.74 micro g/dL vs. 6.89 +/- 2.14 mg, 99.25 +/- 27.15 micro g/dL, respectively, P<0.05]. It is recommended that emphasis be placed on the consumption of food rich in zinc by children, especially those with high family risk of premature CVD