Risk Factor Profiles of Adverse Neuromotor Outcome in Infants

ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay) was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92]), low birth weight (OR = 5.86 [95% CI; 3.07, 11.18]), preterm delivery (OR =6.17 [95% CI; 3.04, 12.52]), Premature rupture of membranes (PROM)>24 hours (OR = 6.18[95% CI; 2.07, 18.51]) and hyperbilirubinemia leading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65]) were associated with an increased risk for neuromotor delay on developmental examination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important

Total dominator total coloring of a graph

Here, we initiate to study the total dominator total coloring of a graph which is a total coloring of the graph such that each object of the graph is adjacent or incident to every object of some color class. In more details, while in section 2 we present some tight lower and upper bounds for the total dominator total chromatic number of a graphs in terms of some parameters such as order, size, the total dominator chromatic and total domination numbers of the graph and its line graph, in section 3 we restrict our to trees and present a Nordhaus-Gaddum-like relation for trees. Finally in last section we show that there exist graphs that their total dominator total chromatic numbers are equal to their orders

Parental participation and mismanagement: a qualitative study of child care in Iran.

The purpose of this study was to explore parents' and nurses' experiences of parental participation in child care in hospitals in Iran. Using thematic analysis, the data were collected through interviewing 14 parents and 11 nurses from two pediatric hospitals. The results showed that four major themes emerged, including the necessity of a parent's presence, the unplanned and informal delegation of care to the parents (which itself had five subthemes: the parents as nurses, the delegation of care without sufficient and planned parental training, informal parent-to-parent support, the continuum of parents' willingness to participate, and the neglect of parents' needs), the inconsistency of care, and the parents as informal evaluators of care. Based on the study's findings, effective communication by nurses with parents is required. Nurses need to make an ongoing assessment of parents' wishes for involvement and negotiate care accordingly, with enough support and supervision to warrant quality of care

Design and psychometric properties of the family support for older people questionnaire

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Total Healthcare Expenditures from the 2017 Iran’s National Households Income and Expenditure Survey: The Application of Two-Part Models

 Introduction: Although the precise estimates of healthcare expenditures are critical for health policy-makers, the right-skewed distribution and a substantial number of zero values of the measures of healthcare expenditure make such estimates challenging. The present study used conventional two-part (CTP) and marginalized two-part (MTP) models to handle the skewness and zero-inflation in expenditure distribution as two serious challenges. Materials and Methods: Data was used from the 2017 Households Income and Expenditure Survey (HIES; 38,252 households), a national cross-sectional study in Iran. CTP and MTP models were utilized to estimate the medical supplies, outpatient, inpatient and total medical expenditures. The rural-urban difference in total medical expenditures and other health services were also examined.   All data analyses were performed using SAS. For all tests, two-sided p-values <0.05 were interpreted as statistically significant.Results: The mean (SD) out-of-pocket spending for total healthcare was $143 ($488) per capita, and $182 ($650) and $105 ($239) for urban and rural areas, respectively. The mean (SD) medical supplies cost per capita was $48 ($240), and the mean (SD) of outpatient cost per capita and inpatient cost per capita were $61 ($245) and $34 ($294), respectively. Both CTP and MTP models suggested that urban population spent more money on total expenditures than rural populations (p<0.05). Although both models gave the same set of parameter estimates, the AIC indicated that the MTP-GG model was a more appropriate fit.Conclusion: The marginalized models provided better estimates in documenting inequalities/healthcare expenditures. Unlike the CTP model, the estimation of covariate effects on the marginal mean of the whole population via using the MTP model is straightforward. However, the MTP model may not outperform the CTP model in all cases. The applications of such models need to be considered in the future research to provide better estimates/documentations of healthcare expenditure and healthcare inequalities. In addition, these findings suggest a substantial inequality in healthcare expenditures between urban and rural areas. Considering the differences in urbanity and rurality can be of interest to health economists and policymakers.