Modeling of in hospital mortality determinants in myocardial infarction patients, with and without type 2 diabetes, undergoing pharmaco-invasive strategy: the first national report using two approaches in Iran

This study was conducted to compare the characteristics of patients, with and without diabetes mellitus, presenting with myocardial infarction (MI) and treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or thrombolytic therapy. Factors related to mortality due to MI in Iran were also determined. This study was a prospective analysis. To analyze the data, Stata software (chi square, t test, Cox and logistic regression) was used. Participants were patients hospitalized for MI for the first time in 540 hospitals from April, 2012 to March, 2013. Out of 20,750 patients with MI, 461 2 (22.3%) had type 2 diabetes. MI case fatality rate was 13.22% (95% CI: 12.24-14.19) and 11.78% (95% CI: 11.28-12.27) in patients with and without diabetes, respectively. The rates of CABG, PCI, and thrombolytic therapy use were 4.2%, 8%, and 58% in patients with diabetes, and 2.1%, 6.5%, and 55% in patients without diabetes. The odds ratio of mortality for ST segment elevation myocardial infarction (STEMI) and chest pain resistant to treatment was, respectively, 6.3 and 2.8 in those with diabetes, and 3.9 and 3.7 in patients without diabetes. The hazard ratio of mortality for gender, education, smoking, left bundle branch block, PCI, and type of MI was different between the two groups (P < 0.05). Characteristics of patients dying post MI were different in those with or without diabetes mellitus. Although use of CABG, PCI, and thrombolytic therapy was more frequent in patients with diabetes than without, mortality was higher in diabetes patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran

Introduction: Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level. Methods: In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models. Results: Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education. Conclusion: A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities

Climate Change and Respiratory Diseases:Relationship between SARS and Climatic Parameters and Impact of Climate Change on the Geographical Distribution of SARS in Iran

Climate change affects human health, and severe acute respiratory syndrome (SARS) incidence is one of the health impacts of climate change. This study is a retrospective cohort study. Data have been collected from the Iranian Ministry of Health and Medical Education between 17 February 2016 and17 February 2018. The Neural Network Model has been used to predict SARS infection. Based on the results of the multivariate Poisson regression and the analysis of the coexistence of the variables, the minimum daily temperature was positively associated with the risk of SARS in men and women. The risk of SARS has increased in women and men with increasing daily rainfall. According to the result, by changes in bioclimatic parameters, the number of SARS patients will be increased in cities of Iran. Our study has shown a significant relationship between SARS and the climatic variables by the type of climate and gender. The estimates suggest that hospital admissions for climate-related respiratory diseases in Iran will increase by 36% from 2020 to 2050. This study demonstrates one of the health impacts of climate change. Policymakers can control the risks of climate change by mitigation and adaptation strategists

Preparing children for climate related disasters

Climate-related disasters affect different dimensions of children’s health and well-being both directly and indirectly. Reducing children’s vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health. As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster’s risks. Main factors in shaping children’s behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that. So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness

Path Analysis Association between Domestic Violence, Anxiety, Depression and Perceived Stress in Mothers and Children’s Development

How to Cite This Article: Vameghi R, Amir Ali Akbari S, Sajedi F, sajjadi H, Alavi Majd H. Path Analysis Association between Domestic Violence, Anxiety, Depression and Perceived Stress in Mothers and Children’s Development. Iran J Child Neurol. Autumn 2016; 10(4):36-48.AbstractObjectiveGiven that several factors involved in the incidence or exacerbation of developmental disorders in children, the present study aimed to investigate the relationship between some of the risk factors affecting mothers’ health and development in children using path analysis. Materials &amp; MethodsThe present cross-sectional analytical study was conducted on 750 mothers and their children in health centers in Tehran, Iran in 2014 enrolled through multi-stage random sampling. Data were collected using a demographic and personal information questionnaire, the Perceived Stress Scale, Beck’s depression Inventory, Spielberger’ anxiety inventory, the WHO domestic violence questionnaire and an ages &amp; stages questionnaire for assessing children’s development. Data were analyzed using SPSS.19 (Chicago, IL, USA) and Lisrel 8.8. ResultsDevelopmental delay was observed in 12.1% of the children. The mean stress score was 23.94±8.62 in the mothers, 50.7% of whom showed mild to severe depression, 84.2% moderate to severe anxiety and 35.3% had been subjected to domestic violence. The path analysis showed that children’s development was affected directly by perceived stress (β=-0.09) and depression (β=-0.17) and indirectly by domestic violence (β=-0.05278) and anxiety (β=-0.0357). Of all the variables examined, depression had the biggest influence on development in the children (β=-0.17). The proposed model showed a good fit (GFI=1, RMSEA=0.034). ConclusionChildren’s development was influenced indirectly by domestic violence and anxiety and directly by perceived stress and depression in mothers. It is thus suggested that more concern and attention be paid to women’s mental health and the domestic violence they experience. References1. R. de Moura D, Costa JC, Santos IS, D. Barros AJ, Matijasevich A, Halpern R, and et al. Risk factors for suspected developmental delay at age 2 years in a Brazilian birth cohort. Paediatr Perinat Epidemiol 2010; 24(3): 211–221.2. Karimzadeh P, Kuimarsi A, Yousefi M. A Survey of Pediatrics Resident Knowledge of Growth &amp; Development. Iran J Child Neurol 2011; 5(2):11-16.3. Baker R. Pediatric Primary Care Well-Child Care. USA. Lippincott Williams and Wilkins Publish. 2001.4. Sachdeva S, Amir A, Alam S, Khan Z, Khalique N, Ansari MA. Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study. 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Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia. Arch Dis Child 2010; 95(10):771-5.60. Avdibegović E, Sinanović O. Consequences of domestic violence on women’s mental health in Bosnia and Herzegovina. Croat Med J 2006; 47(5):730-741.61. Burke JG, Lee LC, O’Campo P. An exploration of maternal intimate partner violence experiences and infant general health and temperament. Matern Child Health J 2008; 12(2):172-9.62. Milgrom J, Holt C. Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomized controlled trial. Trials 2014;15:385.63. Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E. Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 2009; 48(9):919-27.64. Pawlby S, Sharp D, Hay D, O’Keane V. 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Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002; 41(12):1470-7.70. Tang, E, Luyten P, Casalin S, Vliegen N. Parental Personality, Relationship Stress, and Child Development: A Stress Generation Perspective. Inf Child Dev 2015;25(2):179-197

Domestic violence and its associated factors in Iran: according to World Health Organization model

Background and Aim: Domestic violence is a global problem that led to many maternal and neonatal complications. Among the factors associated with domestic violence, social determinants of health are the most controversial issues in health policy domain. According to the WHO conceptual framework of Commission on Social Determinants affecting on health this study has been designed to investigate the articles that have been published on its prevalence and related factors in Iran. Materials and Methods: This descriptive study reviews the Iranian articles published in four data bases (PubMed, SID, Iran Medex, Magiran) between 2000-2013, by searching violence, abuse, pregnancy in title, abstract and keywords of the articles. Results: Overall, 38 articles, 5 English and 33 Persian, were selected according to inclusion criteria and assess. 35 articles were descriptive (longitudinal and cross-sectional) and 3 were analytic (cohort and case-control). Prevalence of domestic violence in pregnancy was reported between 19.3% to 94.5%. Among domestic violence related factors, the most prevalent factors in structural determinant were maternal education and in intermediary determinant were material circumstance: housing, psychosocial circumstance: unwanted pregnancy, behavioral factors: partner substance abuse and health system: lack of prenatal care. ‍Conclusion: The prevalence of domestic violence during pregnancy in Iran is a matter of concern and can be reduced by identifying high risk groups. Since many social determinants may affect domestic violence, performing etiological investigations is recommended

Determinants of safe sexual behavior of female sex workers in Tehran:the woman, her network, and the sexual partner

BACKGROUND: Despite the steady growth of sexual transmission of HIV, there is little evidence about safe sexual behavior of FSWs, and social network effects on this behavior, in Iran. Our aim in this study was to determine the effect of social network characteristics on condom use among FSWs, considering individual characteristics of the FSWs and of their sexual partners, characteristics of their relationship, and the FSW’s personal network. METHODS: A cross-sectional ego-centric network survey of 170 FSWs was carried out in Tehran between January and June 2017. A multilevel ordered logistic regression analysis was conducted to examine the effects of individual and relational characteristics simultaneously. RESULTS: Condom use in sexual relationships of the FSWs on average was rather low. Important determinants of safe sexual behavior were found both at the level of the individual FSW and at the level of the sexual partner. The main determinants at the level of the individual FSW were FSWs’ age and HIV knowledge. At the level of the sexual partner, age and education of sexual partners, as well as intimacy, duration of tie, frequency of contacts with a given partner, frequency of contact, perceived social support, and perceived safe sex norms were significantly associated with condom use. CONCLUSIONS: The findings highlighted that considering only the individual characteristics of female sex workers is not sufficient for effectively promoting condom use. Factors at the network and dyadic level should also be considered, especially the role of sexual partners. Network-based interventions may be useful which modify social relationships to create a social environment that can facilitate changes in sexual behavior

Representation of Disasters in School Textbooks for Children with Intellectual Disabilities in Iran:A qualitative Content Analysis

School textbooks are one of the main sources for teaching and learning in an education system. This study aims to investigate the representation of disasters in school textbooks for the children with intellectual disabilities (ID) in the education system in Iran. This study uses a qualitative content analysis method. All school textbooks for students with ID in the education year 2019-2020 in Iran were collected. Among the whole 164 textbooks, 18 had content about hazards. Data were analyzed qualitatively by MAXQDA 2018 software. Textbooks in most grades cover the topic of disasters triggered by natural hazards including geophysical (earthquakes), hydrological (floods), climatological (extreme temperatures, and drought), meteorological (storms/wave surges) and biological (epidemics and insect/animal plagues). Moreover, there are various topics of disaster risk management in the textbooks including mitigation, preparedness, and response. Natural hazards are well covered in school textbooks for students with ID in Iran. However, more content about sheltering in disasters, reunification, as well as disasters’ response and recovery will help children with ID in Iran to perform better during and after disasters. Moreover, the textbooks in several grades provide some debates on the prevention and the spread of infectious diseases for preparedness against epidemics. The COVID-19 pandemic and the significance of preparedness of vulnerable groups against pandemics evidence that school textbooks are a key means to transfer the information of preparedness in emergencies of all sorts to all children including children with ID

Disaster Risk Reduction in Iranian Primary and Secondary School Textbooks:A Content Analysis

Objective: School textbooks have a significant role in transferring knowledge to the students and changing their behavior. This work aims to analyze school textbooks to find the representation of natural hazards in Iran, which is vital for supporting children in disaster situations. Methods: In this study, a qualitative content analysis was used. Data were analyzed qualitatively by using MAXQDA 2018 software. For the 2019–2020 school year, 300 Iranian school textbooks in Persian language were collected. Results: Findings of this work show that students receive information about disaster risk reduction (DRR) education through the primary and secondary grade levels in all 12 grades. The educational content covers various types of natural hazards, including geophysical, hydrological, climatological, meteorological, and biological disasters. In addition, the textbooks contain discussions about local hazards, causes and effects of disasters, and the disaster management cycle. Conclusions: The coverage of DRR and the relevant contents in school textbooks reveals that the discourse of natural hazards is important for Iranian authorities, especially in the education system. This study helps decision-makers and practitioners design more effective interventions to prepare children for disasters

Correlation between self-esteem and perceived stress in pregnancy and ways to coping with stress

Background and Aim: Stress during pregnancy can have long-term negative consequences on both mother and fetus. Therefore, recognizing the factors that contribute to controlling stress can have a major role in pregnant women’s mental health. The current research was designed to determine the role of self-esteem on the level of stress during pregnancy and the ways to cope with it. Materials and Methods: In this regard, a cross-sectional study was conducted. The city of Tehran was divided into 4 geographic districts including north, south, east and west. A state hospital was elected for each district, and 450 pregnant women (24-32 of gestational week) were randomly chosen from the hospitals. After explaining the purpose of the study and obtaining an informed consent from the qualified pregnant women, they filled out the perceived stress, Rosenberg Self-Esteem and Coping Inventory for Stressful Situations (CISS) questionnaires. Data were analyzed using SPSS software version 19. The level of significance was considered p<0.05. Results: The age of the 450 participating pregnant women was 28.55 years, 78.9 percent had high school or lower education, and 90 percent were housewives. In this study, self-esteem was 21.918.33 and the perceived stress was 20.094.5, respectively. There was a significant inverse correlation between self-esteem and perceived stress. A significant difference was observed between individuals with different levels of self-esteem and the coping styles. ‍Conclusion: It appears that the level of self-esteem of pregnant women is effective on their level of stress and their coping style. By teaching techniques, which increase self-esteem, the level of stress can be decreased in pregnant women