Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran.

OBJECTIVE: to gain a deeper understanding of why Iranian primigravidae request caesarean section without any medical indication. DESIGN: qualitative study. Data were gathered through semi-structured interviews, and thematic analysis was undertaken. SETTING: four health care centres at Hamadan University of Medical Sciences, Hamadan, Iran. PARTICIPANTS: 14 primigravidae who requested caesarean section without any medical indication. FINDINGS: reasons for requesting caesarean section were related to fear of childbirth (labour pain, injury to mother or infant), complications after vaginal delivery (vaginal prolapse, urinary incontinence, sexual dysfunction), trust in obstetricians, and lack of trust in maternity ward staff. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the main reasons given for requesting caesarean section show that there is urgent need for effective antenatal assessment to enable pregnant women to ask questions and express their concerns. In order to promote vaginal birth, there is a need to develop antenatal education and strategies to enhance women's knowledge, confidence and competence about vaginal birth. Health care providers should be re-educated about the observance of medical ethics and professional rules in their practices, and change their attitudes and behaviours to vaginal birth. Evaluation, improvement and change in maternity care policies are recommended to promote natural childbirth.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.

BACKGROUND: The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. METHODS: Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. FINDINGS: 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. INTERPRETATION: Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

Prevalence of metabolic syndrome among staff in a Malaysian public university based on Harmonised, International Diabetes Federation and National Cholesterol Education Program Definitions.

INTRODUCTION: Metabolic syndrome (MetSyn) as defined by the latest Harmonised definition and the agreement between the Harmonised definition and other definitions is poorly studied among Malaysians. This study was conducted to determine and compare the prevalence of MetSyn according to the Harmonised, International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP ATPIII) definitions among Malay staff of Universiti Putra Malaysia (UPM). METHODS: Subjects aged between 20 to 65 years were recruited by convenient sampling. Waist circumference, blood pressure, lipid profiles and fasting plasma glucose levels were assessed. The agreement between the Harmonised and other definitions was determined by Kappa statistics. RESULTS: A total of 227 subjects with a mean +/- SD age of 37.9 +/- 9.6 years participated in the study. The overall prevalence of MetSyn was 38.3%, 38.8% and 33.5% according to Harmonised, IDF and NCEP ATP III definitions, respectively. Generally, men had higher prevalence of MetSyn than women. The prevalence increased with age in both genders with a more progressive trend in women. Men in the age group of 20-39 years had a high prevalence of metabolic syndrome. A strong agreement was found between the Harmonised and the IDF definitions (Kappa index = 0.991), and between the Harmonised and the NCEP ATP III definitions (Kappa index = 0.857). CONCLUSION: Regardless of definitions used, the prevalence of metabolic syndrome in the study, especially in young men, was high and warrants further investigation. The Harmonised definition is suitable for diagnosing metabolic syndrome in any population with similar sociodemographic characteristics.

Reliability and validity of Champion's Health Belief Model Scale for breast cancer screening among Malaysian women.

INTRODUCTION: Breast cancer is the leading cause of cancer deaths in Malaysian women, and the use of breast self-examination (BSE), clinical breast examination (CBE) and mammography remain low in Malaysia. Therefore, there is a need to develop a valid and reliable tool to measure the beliefs that influence breast cancer screening practices. The Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer and screening methods in the Western culture. The purpose of this study was to translate the use of CHBMS into the Malaysian context and validate the scale among Malaysian women. METHODS: A random sample of 425 women teachers was taken from 24 secondary schools in Selangor state, Malaysia. The CHBMS was translated into the Malay language, validated by an expert's panel, back translated, and pretested. Analyses included descriptive statistics of all the study variables, reliability estimates, and construct validity using factor analysis. RESULTS: The mean age of the respondents was 37.2 (standard deviation 7.1) years. Factor analysis yielded ten factors for BSE with eigenvalue greater than 1 (four factors more than the original): confidence 1 (ability to differentiate normal and abnormal changes in the breasts), barriers to BSE, susceptibility for breast cancer, benefits of BSE, health motivation 1 (general health), seriousness 1 (fear of breast cancer), confidence 2 (ability to detect size of lumps), seriousness 2 (fear of long-term effects of breast cancer), health motivation 2 (preventive health practice), and confidence 3 (ability to perform BSE correctly). For CBE and mammography scales, seven factors each were identified. Factors for CBE scale include susceptibility, health motivation 1, benefits of CBE, seriousness 1, barriers of CBE, seriousness 2 and health motivation 2. For mammography the scale includes benefits of mammography, susceptibility, health motivation 1, seriousness 1, barriers to mammography seriousness 2 and health motivation 2. Cronbach's alpha reliability coefficients ranged from 0.774 to 0.939 for the subscales. CONCLUSION: The translated version of the CHBMS was found to be a valid and reliable tool for use with Malaysian women. It can be used easily to evaluate the health beliefs about breast cancer, BSE, CBE and mammography and for planning interventions. For greater applicability, it is recommended that this tool be tested among ethnically diverse populations.

Prevalence of smoking and drinking habits among Form Six students in Petaling District, Selangor.

Smoking and alcohol intake patterns may persist from adolescence to adulthood. The aims of this study are to determine the prevalence and factors associated with smoking and drinking habits among Form Six students. This was a cross-sectional study conducted in January 2003 among Form Six students from government schools in the Petaling District, Selangor. A hundred and thirty six self-administered questionnaires were distributed to students selected through multistage stratified sampling. Response rate in this study was 90.1% (136/151). The respondents were mainly Chinese 60 (44.1%) and female 88 (64.7%). The prevalence of smoking was 22.8%, whereas the prevalence of alcohol intake was 47.8%. Only 33.1% of the respondents practiced undetermined activities and 1.5% have undetermined characters. There were significant associations between smoking and males (Adjusted OR 2.56, 95% CI 1.02-6.43) and smoking and alcohol intake (Adjusted OR 2.74, 95% CI 1.11-6.78). Alcohol intake has significant negative association with Malays (Adjusted OR 0.83, 95% CI 0.03-0.27). Smoking habits among adolescents were associated with males and alcohol intake. However, only alcohol intake was negatively associated with Malays. Program interventions to reduce behavioral problems, particularly smoking and alcohol intake should be emphasized.

Breast cancer and lifestyle risks among Chinese women in the Klang Valley in 2001.

Breast cancer is one of the commonest cancers among women in Malaysia. The relation between lifestyle practices and the risk of breast cancer in Chinese women aged 21-55 years were assessed using data collected from June to October 2001, via a face-to face interview in a case control study in the Breast Clinics of Kuala Lumpur Hospital and University Malaya Medical Centre. A total of 89 cases with breast cancer were compared with 85 controls without the disease. Our study showed that breastfeeding had an odds ratio of 4.43 after adjustment for confounders. The results add to the evidence of a protective association between breast feeding practices and breast cancer particularly among Chinese women receiving treatment at two government hospitals in the Klang Valley.